Facial Soft Tissue Research Articles

Féminisation du regard

Eye feminization embraces surgical and non-surgical aesthetic procedures used in order to feminize upper third of the face. Eye feminization is indicated for transwomen during facial gender affirming surgery, and also for aging women. During aging, volume of facial osseous and soft tissues is decreasing, the orbit is squeletonizing, with skin sagging, evolving in a more masculine appearance of the orbital area. Upper eye area analyze (forehead, temple, eyebrow, eyelid, external canthus) as lower eye area analyze (zygoma, dark circle, palpebral bags, eyelid skin) must be assessed in preferential order in order to maximize good post-therapeutic results. Procedures include bony surgery (frontoplasty, orbitoplasty), browlift, external canthoplasty, fat grafting, and also classic eyelid surgery or aesthetic medicine injections.

Congenital heterotopic gastrointestinal duplication cyst of the face: a rare case report

Gastrointestinal duplication (GDC) cysts have various synonyms; choristoma, enterocystoma, and duplication cyst. They are infrequent congenital benign lesions diagnosed mainly in children in the first decade of life, comprising approximately less than 5% of the pediatric population with a predilection for the male sex. It is exceedingly rare in the oral cavity but it is possible, particularly on the tongue, floor of the mouth, and pharynx. From 1895 until 1994, 30 cases of this lesion in the oral cavity were reported. Nowadays, none of the authors reported a GDC in the facial region. We report an exceptional case of heterotopic gastrointestinal duplication cysts (HGDC) in the facial region of a 13 -years -old male teenager who was referred to our medical department for an evaluation of a painless progressive facial asymmetry. In the first instance, the ultrasound facial soft tissue was made with a 6.5 MHz convex transducer, reporting a big anechoic image with regular borders to a 60 x 26 x 56 mm diameter with a 46cc approximate volume. Following this, a non-contrast magnetic resonance image was executed with an open Philips PanoramaⓇ machine performed at 3T, reporting a hyperintense image in T2-weighted (repetition time msec/echo time msec: 5,500/112) sagittal sequence and FLAIR-weighted (5,714/80) axial sequence; and an isointense image in T1-weighted (24/80) coronal sequence to 54 x 30 x 51 mm diameter compatible with space occupant lesion with interior walls. A complete tumor resection was achieved under balanced general anesthesia, and the specimen was sent for histological examination. Microscopic examination showed a cystic cavity lined mostly by mucous secretory gastrointestinal epithelium and other areas by stratified squamous epithelium. The cystic wall was composed of fibrous connective tissue and contains abundant gastric cells. Its deepest portion exhibits a smooth muscle layer. In summary, HGDC is an unusual congenital head and neck lesion, but it should be considered in the differential diagnosis of neonates and children. The diagnosis of gastrointestinal tract duplications may be suggested by imaging studies; however, the correct diagnosis is defined by histopathologic analysis. Due to the risk of destruction potential and malignant transformation, HGDC should be treated surgically by complete excision.

Hasil analisis sefalometri metode holdaway pasien ortodonti usia 19-26 tahun di rsgm – p fkg usakti

Background: Malocclusion is a discrepancy in the relationship between the jaw and tooth that deviates from normal. To fix the malocclusion problem in the oral cavity, orthodontic treatment can be used in performed. Cephalometric analysis can be used in determining the diagnosis and treatment plan. One of the analysis is the Holdaway method. Holdaway analysis is considered as a more precise method, making it easier for researchers analysis in orthodontic patients to assess facial soft tissue and facial hard tissue structures effectively because it has 11 parameters; facial angle, nose tip distance, superior labial sulcus depth, inferior labial sulcus depth, upper lip curvature, upper lip distance, chin thickness, upper lip thickness, upper lip curvature, upper lip strain, H angle and skeletal curvature. Purpose: To determine the results of cephalometric analysis in adult orthodontic patients aged 19-26 years at RSGM-P FKG Usakti with Holdaway analysis. Methods: A descriptive observational study with a cross-sectional design, and selection of cephalograms by purposive sampling in adult orthodontic patients at RSGM-P FKG Usakti in 2021-2022. Results: The average patient's facial angle was 89⁰, the average distance from the apex of the nose was 2,5mm, the mean superior labial sulcus depth was 7,82mm, the mean labial sulcus depth inferior 4,3mm, mean Li-H distance of 1,30mm, mean thickness of the chin 12,6mm, average thickness of the upper lip 12,6, mean Sn-H 5mm, mean upper lip strain of 11,70mm, mean skeletal convexity of 3,4mm, and mean angle H 16.15⁰. Conclusion: Overview of cephalometric analysis in orthodontic patients with Holdaway analysis shows that the patient has a facial profile with facial angle, H angle and convex skeletal convexity, small nasal tip distance, superior labial sulcus depth, inferior labial sulcus depth and less chin thickness ideal, upper lip curvature and less than ideal upper lip strain, and ideal Li to H distance

Evaluation of Dentoskeletal and Profile Changes with Distal Jet in Moderate Skeletal Class II Patients

In an orthodontic treatment, upper molar distalization is mandatory to gain space in upper arch. Objective: To evaluate the nature of molar distalization & its effects on soft tissue profile, dentoalveolar structures & skeletal structures. Methods: This was a retrospective study design. 20 subjects were found to be eligible for the distalization with average age of 19.4 yrs. Only Distal jet was used for distalization and one operator was there for all the subjects. Pre and post treatment cephalograms were taken to analyze dentoalveolar & soft tissue changes. Paired sample T test was used. Results: Notable amount of molar distalization and increased lower face height was achieved. Conclusions: This study verified definite distalization of maxillary first molars using distal jet showing a better bodily movement with less tipping movement, with certain unwanted & reactionary effects on incisor position & limited effects on facial soft tissues.

Do facial soft tissue thicknesses change after surgeries correcting dental malocclusions? An intra- and inter-patient statistical analysis on soft-tissue thicknesses in BSSO + LFI surgeries.

The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.

A computerized facial approximation method for Homo sapiens based on facial soft tissue thickness depths and geometric morphometrics.

Facial approximation (FA) provides a promising means of generating the possible facial appearance of a deceased person. It facilitates exploration of the evolutionary forces driving anatomical changes in ancestral humans and can capture public attention. Despite the recent progress made toward improving the performance of FA methods, a limited understanding of detailed quantitative craniofacial relationships between facial bone and soft tissue morphology may hinder their accuracy, and hence subjective experience and artistic interpretation are required. In this study, we explored craniofacial relationships among human populations based upon average facial soft tissue thickness depths (FSTDs) and covariations between hard and soft tissues of the nose and mouth using geometric morphometrics. Furthermore, we proposed a computerized method to assign the learned craniofacial relationships to generate a probable facial appearance of Homo sapiens, reducing human intervention. A smaller resemblance comparison (an average Procrustes distance was 0.0258 and an average Euclidean distance was 1.79 mm) between approximated and actual faces and a greater recognition rate (91.67%) tested by a face pool indicated that average dense FSTDs contributed to raising the accuracy of approximated faces. Results of partial least squares (PLS) analysis showed that nasal and oral hard tissues have an effect on their soft tissues separately. However, relatively weaker RV correlations (<0.4) and greater approximation errors suggested that we need to be cautious about the accuracy of the approximated nose and mouth soft tissue shapes from bony structures. Overall, the proposed method can facilitate investigations of craniofacial relationships and potentially improve the reliability of the approximated faces for use in numerous applications in forensic science, archaeology, and anthropology.

Surgical Emphysema without Pneumothorax: A Diagnostic Dilemma

Surgical emphysema, also widely known as subcutaneous emphysema, is defined as a clinical state in which air gets trapped subcutaneously. The etiology may be traumatic or atraumatic, and multiple causes in each are present.&#x0D; Case report. A 63-year-old female patient presented to the emergency room with a facial soft tissue injury following road traffic accident and developed surgical emphysema later on with no evidence of rib fractures or pneumothorax. Infectious etiology was ruled out. Due to the respiratory embarrassment, the patient was electively intubated. Conservative management was provided. Emphysema resolved within 24 hours after the accident.&#x0D; Discussion. Various theories have been outlined in literature, like Mackler effect, Crampton theory and ballvalve mechanism. In our case, it was difficult to apply any of these theories to confirm the diagnosis. Conservative management is still used in the treatment of surgical emphysema.&#x0D; Conclusion. Surgical emphysema is a common encounter in trauma practice, and its identification is essential to rule out any emergency causes which may lead to respiratory distress.

RELATIONSHIP BETWEEN THE ANGLE OF INCLINATION OF THE MAXIMUM INCLINATION TO THE SOFT TISSUE OF THE FACIAL IN BALINESE WOMEN USING THE HOLDAWAY METHOD

Introduction: Disharmony between tooth position, jaw relation and facial soft tissue has a significant effect on facial appearance. Anatomical facial appearance is determined by the lower third of the face, especially the position of the lips and related parts which are affected by the inclination of the anterior teeth. The purpose of this study was to determine whether there was a correlation between the angle of inclination of the maxillary incisors and the convexity of facial soft tissue in Balinese women using the Holdaway method. Materials and Method: This type of research was analytic observational with a cross sectional approach. This study used a sample of 31 lateral cephalometric photographs of Balinese females for tracing. Samples were taken by means of purposive sampling, based on specified criteria. Results and discussion: Pearson correlation analysis showed that the relationship between the angle of inclination of the upper incisors was significant. Conclusion: Based on this study, it can be concluded that there was a correlation between maxillary incisor inclination angle on the facial soft tissue convexity in Balinese females using the Holdaway method.

The relationship between biological parameters and facial soft tissue thickness measured by ultrasound and its forensic implications.

Facial soft tissue thickness (FSTT) data are currently widely used in forensic and medical science. In the forensic sciences, they form the basis for craniofacial reconstruction and identification methods. Since there are few FSTT data in the Slovak population, this study aims to enrich the data in well-defined age categories, taking into account differences between sexes and body mass index (BMI). The sample consisted of 127 participants aged 17 to 86 years from Slovakia. In addition to biological sex and age information, stature and body weight were recorded to calculate BMI. Subsequently, 17 facial anthropometric landmarks were used to measure FSTT using a noninvasive General Electric LOGIQe R7 ultrasound device. The mean values of FSTT were greater in the mouth region in males and in the zygomatic and eye regions in females. Differences between males and females, regardless of sex and BMI, were significant only at two landmarks. When BMI and age were taken into account, there were differences in 12 of 17 landmarks. Linear regression results showed the strongest correlation of most landmarks with BMI, followed by age and sex. When the FSTT was estimated in association with sex/age/BMI, landmarks in the zygomatic, mandibular, and frontal regions were the best regressors. The results of the present study demonstrate that B-mode ultrasound measurements of FSTT can be used in facial reconstruction as a function of BMI, age, and sex of the subject. Furthermore, the present regression equations can help practitioners in the forensic/medical field to calculate individual tissue thickness.

Application of Surgery-First Approach in Treating Skeletal Dentofacial Asymmetry with Orthognathic Surgery.

Skeletal dentofacial asymmetry decreases patient's attractiveness by deteriorating symmetry of facial appearance which is of great significance to individuals. Surgery-first orthognathic approach manifests its advantages of shortening treatment time and improving patient's quality of life. However, current literature on surgery-first approach mainly focuses on treating prognathism, overlooking its efficacy in improving facial symmetry of skeletal dentofacial asymmetry patients. This study aimed to assess SFA's efficacy in improving facial appearance by analyzing morphological features of asymmetric bone and facial soft tissue in a three-dimensional manner. Thirty-four patients who received orthognathic surgery in a surgery-first fashion were included. Based on three-dimensional CT reconstruction, bilateral preoperative morphological features and postoperative symmetry of hard tissue were compared respectively. Efficacy of facial soft tissue symmetry restoration was evaluated using root mean square deviation (RMSD). Asymmetric features mainly located in menton, mandibular body length, angulation between ramus and midsagittal plane (MSP), distance between gonion and MSP and so on, which were significantly restored after the whole treatment. RMSD of facial soft tissue surface were significantly declined after the treatment and prognathism was corrected simultaneously if existed. Surgery-first orthognathic approach is proved to be capable of treating skeletal dentofacial asymmetry effectively and efficiently.

A novel technique for repositioning facial soft tissues with barbed polydioxanone threads based on the main aging vector force of rejuvenation

Background: With the evolution of facial rejuvenation procedures, thread lifts have gained space among western patients who seek cosmetic improvement without undergo to surgeries. Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available, and in mid-lower face and mandibular jowl lift, threads are most often implanted in a diagonal vector force from medial-inferior up to lateral-superior site, near the temple. Herein, the authors introduce a new technique based on this oblique sum of anti-aging vector force to reposition and anchorage facial soft tissues, aimed for natural youth rejuvenation. Objective: Describe a novel technique for counteracting the facial ptosis and laxity skin, as well as the duration of clinical lifting result and of skin quality improvement. Methods: More than 84 patients were underwent in this thread technique once. The outcomes were assessed objectively using serial photography and subjectively based on the patients’ spontaneous satisfaction through over these 4 years. Complications were also reported. Results: Most patients considered the results satisfactory. The incidence of complications was low, and most of them were minor and temporary. Conclusion: Wedge-shaped PDO thread repositioning and anchorage soft tissue is safe and effective method for rejuvenation.

Assessment of the Effect of Chin Augmentation with Hyaluronic Acid Filler on Facial Soft Tissues Using Lateral Cephalometric Radiograph

Assessment of the Effect of Chin Augmentation with Hyaluronic Acid Filler on Facial Soft Tissues Using Lateral Cephalometric Radiograph

Hard and Soft Tissue Alterations After Immediate Implant Placement and Provisionalization with Customized Definite Abutment in Esthetic Zone: A Retrospective Study.

To evaluate the hard and soft tissue alterations of immediate implant placement and provisionalization with customized definitive abutments in the esthetic zone. Single unsalvageable maxillary anterior teeth were replaced with immediate implant placement and provisionalization with definitive abutments in 22 participants. Digital impressions and CBCT images were obtained presurgery, immediately after surgery, and 6 months after surgery. Horizontal and vertical buccal bone changes in thickness and height (HBBT, VBBH), vertical changes for the gingiva margin, mesial and distal papilla height, and horizontal changes for soft tissue (HCST) were analyzed using a 3D superimposition method. Twenty-two participants completed the study. No implant failed, and there were no mechanical or biologic complications for any patients. At 6 months after surgery, the mean HBBT changes at 0, 1, 2, 3, 5, 7, 10, 11.5, and 13 mm were -0.92 ± 0.73, -0.83 ± 0.53, -0.82 ± 0.49, -0.70 ± 0.64, -0.65 ± 0.47, -0.50 ± 0.51, -0.15 ± 0.45, -0.10 ± 0.57, and -0.00 ± 0.64 mm, respectively. The mean VBBH change was -0.61 ± 0.76 mm. The mean HCSTs at -3, -2, -1, 0, 1, 2, and 3 mm sub- and supra-implant shoulder were -0.65 ± 0.54, -0.70 ± 0.56, -0.65 ± 0.51, -0.61 ± 0.56, -0.47 ± 0.54, -0.47 ± 0.59, and -0.46 ± 0.59 mm, respectively. The mean gingiva margin recession was -0.38 ± 0.67 mm. The mean mesial papilla height recession was -0.03 ± 0.50 mm. The mean distal papilla height recession was -0.12 ± 0.56 mm. The definitive abutment used with immediate implant placement and provisionalization could potentially maintain the buccal bone thickness and height. For the facial soft tissue, it also benefited the maintenance of the midfacial gingival margin position and papilla height during the 6-month follow-up. Int J Oral Maxillofac Implants 2023;38:479-488. doi: 10.11607/jomi.9914.

An Automated Method of 3D Facial Soft Tissue Landmark Prediction Based on Object Detection and Deep Learning.

Three-dimensional facial soft tissue landmark prediction is an important tool in dentistry, for which several methods have been developed in recent years, including a deep learning algorithm which relies on converting 3D models into 2D maps, which results in the loss of information and precision. This study proposes a neural network architecture capable of directly predicting landmarks from a 3D facial soft tissue model. Firstly, the range of each organ is obtained by an object detection network. Secondly, the prediction networks obtain landmarks from the 3D models of different organs. The mean error of this method in local experiments is 2.62±2.39, which is lower than that in other machine learning algorithms or geometric information algorithms. Additionally, over 72% of the mean error of test data falls within ±2.5 mm, and 100% falls within 3 mm. Moreover, this method can predict 32 landmarks, which is higher than any other machine learning-based algorithm. According to the results, the proposed method can precisely predict a large number of 3D facial soft tissue landmarks, which gives the feasibility of directly using 3D models for prediction.

107. Facial Feminization Surgery: Region-specific Importance Recognized by Artificial and Human Intelligence Gender Recognition Correlates with Patient Satisfaction

PURPOSE: Facial Feminization Surgery (FFS) has emerged as an important aspect of social gender confirmation for trans women through modifications to the facial hard and soft tissues. However, there is limited information about which of the many FFS procedures are the most important. To determine this, individual FFS procedures or regional changes were compared preoperatively and postoperatively using gender typing from both artificial intelligence (neural networks trained on facial features) and public opinion (online crowdsourcing survey). METHODS: For both studies, standardized frontal and lateral view preoperative and postoperative images were used; in addition, unoperated control cis-gender males and cis-gender females were included. Part I: The outcome of 12 different individual FFS procedures (eg. osseous genioplasty vs rhinoplasty) or facial regions (eg. forehead vs chin) (n=303 patients) was comparatively analyzed using four neural networks (AI which have been trained to recognize facial images to assess gender) and crowdsourcing public opinion of gender type (n=917) to measure changes in correct gender-typing, improvement in gender typing (preop vs postop), and confidence in femininity. Part II: The nasofrontal region (frontal sinus setback/rhinoplasty) was separated into subtypes based on morphologic typing of the preoperative severity (Types 1-3) and change was compared for success in FFS using neural networking and crowdsourcing. In addition, FACE-Q surveys were used to assess patient-reported facial aesthetic outcome. RESULTS: All four neural network platforms provided a gender. For all four neural networks, cis-male and cis-female control images were gendered correctly 98% and 99% of the time respectively. Preoperative FFS patient images were recognized as female only 52% of the time. With postoperative FFS, a combination of all the procedures followed by correction of the nasofrontal region had superior outcomes (98%, 96% correct gendering) compared to other facial regions (range 68-86%). With public opinion, similar results were recorded, with a combination of all the procedures followed by correction of the nasofrontal region having superior outcomes (97%, 95% correct gendering with improved confidence levels of 8.9+1.2 and 8.1+2). For the nasofrontal region, improved outcome in correct gendering was seen with a more severe preoperative state (Type 3 brow/dorsal hump) and increased change in measured nasofrontal angle (from 90o to 135o). Finally, FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1+8.1) and quality of life (82.4+8.3). There was a positive correlation between less AI and public misgendering and patient reported FACE-Q scores for appearance, quality of life, and overall satisfaction. CONCLUSION: The success of FFS (patients more likely to be correctly identified as female) was demonstrated by both artificial and human intelligence methods. For FFS feature changes, both all and nasofrontal regions should be considered the most important for less misgendering by artificial and human intelligence; these outcomes positively correlated with patient satisfaction.

Palatal asymmetry assessed by intraoral scans: effects of sex, orthodontic treatment, and twinning. A retrospective cohort study

BackgroundSymmetry is critical in perceived attractiveness, especially in female faces. The palate determines the teeth’ alignment and supports facial soft tissues. Therefore, the study aimed to assess the effects of sex, orthodontic treatment, age, and heritability on the directional, anti-, and fluctuational asymmetry in the digital palatal model.MethodsThe palate of 113 twins, 86 female and 27 male subjects, with and without previous orthodontic treatment, were scanned by the Emerald (Planmeca) intraoral scanner. Three lines were constructed horizontally in the digital model, one between the right and left first upper molars and two between the first molars and incisive papilla. Two observers calculated the left and right angles between the mid-sagittal plane and molar-papilla lines. The intraclass correlation coefficient was used to assess the inter-observer absolute agreement. The directional symmetry was determined by comparing the mean left and right angles. The antisymmetry was estimated from the distribution curve of the signed side difference. The fluctuating asymmetry was approximated from the magnitude of the absolute side difference. Finally, the genetic background was assessed by correlating the absolute side difference between monozygotic twin siblings.ResultsThe right angle (31.1 degrees) was not significantly different from the left one (31.6 degrees). The signed side difference followed a normal distribution with a mean of -0.48 degrees. The absolute side difference (2.29 degrees, p < 0.001) was significantly different from zero and negatively correlated (r=-0.46, p < 0.05) between siblings. None of the asymmetries was affected by sex, orthodontic treatment or age.ConclusionsThe palate illustrates neither directional asymmetry nor antisymmetry, indicating that most people’s palates are symmetric. However, the significant fluctuating asymmetry suggests that some subject has considerable asymmetry but is not influenced by sex, orthodontic treatment, age, and genetics. The proposed digital method is a reliable and non-invasive tool that could facilitate achieving a more symmetrical structure during orthodontic and aesthetic rehabilitation.Trial registrationThe Clinicatrial.gov registration number is NCT05349942 (27/04/2022).

Facial Soft Tissue Thickness Values for Romanian Adult Population

Introduction: Forensic identification practice requires a multitude of methods for positive identification, among which the facial reconstruction occupies a high place. For this to be done in the best way possible, it is mandatory that each population have their own database regarding soft tissue thickness. Objective: The present research is focused on creating such a database for the Romanian adult population and on exploring the statistical distribution and correlation of craniometric landmarks, overall, and in groups defined according to sex and weight categories. This might provide support in estimating the values of missing landmarks or other variables (e.g., age, sex) for unidentified bodies. Methods: Twelve craniometric landmarks were measured on 100 cadavers less than 24 h after death. Results and discussions: Of the 12 anatomical landmarks, only one appears to manifest statistically significant differences between sexes, and seven landmarks appear to vary significantly among the weight categories. Additionally, some evidence of interpopulation differences in the average soft tissue thicknesses were observed by the comparison of these data with similar studies from Caucasian groups with different geographic origin. Additionally, correlations between facial landmarks were examined, overall and between sexes.

Application of vertical transposition flap in closure for large facial soft tissue defects in children.

While transposition flap is widely used for the repairs of facial defects, few studies has reported its application among children with large defects. In this study, we aimed to investigate the surgical techniques and principles in different locations on face of vertical transposition flap in children. We retrospectively reviewed our hospital database and identified children who were treated with vertical transposition flap for large facial defects between January 2014 and December 2021. Information was collected including patients' demographics, location and dimension of the lesion, surgical procedure, additional surgeries, complications, and outcomes. A total of 122 patients (77 boys, 63.1%) were included in this study. The average age for participants was 3.3 years (3 months to 9 years). One hundred and four (85.3%) patients had melanin nevus and 18 (14.8%) had sebaceous nevus. The average size of defects was 5.8 cm2 (ranging from 0.8-16.5 cm2). Ten patients (8.2%) suffered from dermal layer or full-thickness necrosis in the distal part of their flaps, They all recovered after conservative treatment and there were noticeable scars at discharge. Five patients (4.1%) had slight traction of the mouth and eyelid, all recovered about 2 week after surgery. An acceptable cosmetic outcome was achieved for all the patients at last time follow-up. Repairing large facial defects with vertical transposition flap is effective in Children, especially on forehead, cheek and mandible. However, this technique is far from perfect. Careful selection of appropriate patients and flap design might be needed.

Structural equation modelling to estimate facial soft tissue thickness parameters based on ethnicity, gender and body mass index: a secondary study on an Iranian dataset.

According to theanthropological importance of soft facial tissue thickness parameters, we aimed to find the association of these parameters with Lur and Arab ethnicities, gender and body mass index (BMI). Structural equation modeling (SEM) was used. As a secondary analysis, SEM was performed on a dataset of 100 participants. The participants were from Lur and Arab populations of Ahvaz province, Iran, from those who referred for magnetic resonance imaging (MRI) due to headache. Multivariate regression illustrated that mental eminence (ME), chain-lip fold (CLF) and end of nasals (END) could not be predicted by the independent variables (p > 0.05). Right masseteric region (RMST) had the maximum predictability with R2 = 0.365, followed by middle philtrum (MID) with R2 = 0.358 (p < 0.001). With respect to our criterion to enter SEM, i.e. existing at least two significant covariates at significance level of 0.05, among staying parameters, only parameters of nasion (NA), MID, superior lip (SL), RMST and left masseteric region (LMST) remained. Among these cases, MID was the only parameter that its three covariates illustrated significant association. MID parameter can be predicted by gender, BMI and Arab ethnicity. By carrying out such studies and creating database, such information can be used in plastic surgery, corpse identification, and facial reconstructionsoftware in archeology.

Limberg flap revisited: for closure of facial soft tissue defects

The Limberg or rhomboid flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The purpose of this paper is to demonstrate the versatility that a single flap can be used to close defects almost anywhere on the body. This study was conducted in the department of plastic and reconstructive surgery, Saveetha Medical College and Hospital, during the period between January 2018 and December 2019. Twenty patients (fifteen males and five females) took part in this study. Their ages ranged from 20-60 years with a mean age of 42 years. From each patient history was taken and physical examination was performed. All the procedures were done under local anesthesia. Postoperatively suture removal was done on the 5th post-operative day. There were twenty patients who took part in the study. Seventeen patients had naevi and three had basal cell carcinoma. The size of the lesions ranged from 2.0×1.8 cm to 4.8×4.5 cm. All the flaps settled well with no complications. The procedure resulted in a very fine and less noticeable scar with smooth contour of the skin which was acceptable in all patients. Limberg flap is a safe and reliable option that could be used in the reconstruction of small and medium‐sized cutaneous defects of the face especially in elderly patients with no morbidity.