Improvement In Facial Appearance Research Articles

Correction of Skeletal Class II Malocclusion using Functional-Fixed Appliance Therapy

Single-phase treatment started during late mixed dentition using functional followed by fixed appliance therapy has proven to be the most effective approach to achieve correction of Class II malocclusion. This case report demonstrates the use of this treatment approach in an 11-year-old girl with skeletal and dental Class II malocclusion, large overjet, deep overbite, increased incisor exposure and a gummy smile. She was given a functional appliance for 1 year which was immediately followed by fixed mechanotherapy for final finishing and detailing of the occlusion. The magnitude of skeletal and dental correction achieved, along with the dramatic improvement in facial appearance of the patient, provides a strong case for establishing the efficacy of this treatment modality.

Further Enhancement of Facial Appearance With a Hydroquinone Skin Care System Plus Tretinoin in Patients Previously Treated With Botulinum Toxin Type A

A hydroquinone (HQ) skin care system has been designed for use in conjunction with nonsurgical procedures. The authors evaluate the efficacy of this system plus tretinoin for improving facial appearance in comparison to a standard skin care regimen in users of botulinum toxin Type A (BoNT-A). In this multicenter, randomized, investigator-masked, parallel-group study, 61 patients who received upper facial treatment with BoNT-A at a plastic surgery or dermatology clinic were randomly assigned to apply either the HQ system (cleanser, toner, proprietary 4% hydroquinone, exfoliant, and sunscreen) plus 0.05% tretinoin cream or a standard skin care regimen (cleanser, moisturizer, and sunscreen) for 120 days. Outcomes were assessed by the investigators and through a patient questionnaire. Compared with standard skin care, the HQ system plus tretinoin resulted in significantly milder fine lines/wrinkles and hyperpigmentation at Days 30, 90, and 120 (p ≤ .05) and significantly superior overall ratings for each of nine patient assessments at Days 90 and 120 (p ≤ .05). A relatively greater proportion of patients using the HQ system plus tretinoin believed that their study treatment had further enhanced the improvements attained with BoNT-A (86% vs 8%). Both regimens were generally well tolerated. Adjunctive use of the HQ system plus tretinoin can further enhance the improvements in facial appearance attained with BoNT-A. Applying the HQ system plus tretinoin offers multiple clinical benefits over standard skin care, including significantly greater improvements in fine lines/wrinkles and hyperpigmentation.

Modified Intraoral Inverted “L” Osteotomy: A Technique for Good Visibility, Greater Bony Overlap, and Rigid Fixation

The sagittal split-ramus osteotomy (SSRO), intraoral vertical ramus osteotomy (IVRO), and intraoral inverted “L” osteotomy (IVLO) are common surgical procedures used to correct mandibular prognathism. Of these, the SSRO maintains its popularity because of its versatility and its amenability to rigid fixation. 1 Wolford L.M. The sagittal split ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg. 2000; 58: 310 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar However, there is a variable but considerable risk of long-term injury to the inferior alveolar nerve when performing this procedure. 2 MacIntosh R.B. Experience with sagittal osteotomy of the mandibular ramus: A 13-year review. J Oral Maxillofac Surg. 1981; 9: 151 Google Scholar , 3 Nishioka G.J. Zysset M.K. van Sickles J.E. Neurosensory disturbance with rigid fixation of the bilateral split osteotomy. J Oral Maxillofac Surg. 1987; 45: 20 Abstract Full Text PDF PubMed Scopus (143) Google Scholar , 4 Blomqvist J.E. Alberius P. Isaksson S. Sensibility following sagittal split osteotomy in the mandible: A prospective clinical study. Plast Reconstr Surg. 1998; 102: 325 Crossref PubMed Scopus (51) Google Scholar The popularity of this technique is a testimony to its versatility and acceptance by patients, despite a possible sensory deficit. 5 Leira J.I. Gilhuus-Moe O.T. Sensory impairment following sagittal split osteotomy for correction of mandibular retrognathism. Int J Adult Orthod Orthognath Surg. 1991; 6: 161 PubMed Google Scholar One might assume that such a complication might be compensated for by great improvements in facial appearance and chewing capacity. 6 Westermark A. Bystedt H. von Konow L. Patients' evaluation of the final result of sagittal split osteotomy: Is it influenced by impaired sensitivity of the lower lip and chin?. Int Adult Orthod Orthognath Surg. 1999; 14: 135 PubMed Google Scholar Even if a nerve injury results in only a mild paresthesia, which most patients tolerate well, the complication should be avoided if possible.

The use of anthropometric proportion indices in the measurement of facial attractiveness

This study used anthropometric data in the form of Farkas' proportion indices in order to quantify facial attractiveness, and to relate measured change through surgery, to clinical judgement. Standardized photographs of 15 orthognathic patients were used in album form and rated by 10 experienced clinicians: album 1 for facial attractiveness (before surgery) and album 2 for improvement in facial attractiveness (before and after surgery). Twenty-five proportion indices were selected and linear measurements recorded from the pre- and post-surgical photographs. The corresponding change in indices and in clinicians' scores were compared. The clinicians' assessment of the degree of improvement in facial appearance achieved through surgery, related closely to the scores produced by the change in proportion indices (r = 0.698, P = 0.004). Clinical assessment demonstrated a clear inverse relationship between initial attractiveness rating and the degree of improvement achieved through orthognathic surgery (r = -0.781, P = 0.001). The results showed good repeatability in terms of clinical assessment, photography and digitization. The method would appear to have potential for further development, possibly into a 'facial attractiveness index' for the objectives of quantification of improvement achieved through treatment.

Improvement of Facial Appearance and Nocturnal Breathing with Geniotomy (Sliding Genioplasty): Report of Two Cases

Improvement of Facial Appearance and Nocturnal Breathing with Geniotomy (Sliding Genioplasty): Report of Two Cases

TWIN BLOCK (Studi Pustaka)

Young patients with class II skeletal malocclusion are often found. To avoid further discrepancy of this case, myofunctional therapy is one of the options. Functional appliance often used for such treatment. Functional appliance has been modified since activator was introduced by Andresen. With its bulky shape, activator makes difficulty for patient to speak and eat. Patient unable to wear it full time due to uncomfortness and negative facial appearance. In 1977, Clark developed twin block to overcome the weakness of previous appliances. A more simple design allows patient to be more comfortable and willing to wear it longer. Twin block is myofunctional appliance to reposition the mandible forward for skeletal class II correction with retruded mandible. This paper describes the design, clinical management effects of twin block treatment and brief case presentation using twin block appliance. Similar to the study reports found, this case revealed improvement of facial appearance, decrease overjet and overbite, improvement of molar relationship and good compliance of patient.

Craniofacial fibrous dysplasia of the fronto-orbital region: A case series and literature review

Purpose: Craniofacial fibrous dysplais (CFD), involving the fronto-orbital region often is challenging to treat because of the proximity of neurovascular and ocular structures. This article presents the surgical experience with 6 patients. Patients and Methods: Six patients ranging in age from 7 to 23 years, who had undergone surgery for CFD of the orbital region, were retrospectively reviewed. All patients had progressive complaints of deformity, pain, paresthesia or visual disturbances. Surgery generally involved extensive tumor excision and immediate orbital reconstruction with autogenous bone grafts. Two patients also were reconstructed with resected and treated autogenous bone, which then was immediately reimplanted, using rigid fixation. Three patients also had intracranial microsurgical optic canal decompression. All patients received perioperative corticosteroids. Results: Five patients experienced partial relief of their sensory and visual disturbances. These patients also felt that there had been improvement in facial appearance. One patient with very extensive circumferential optic canal involvement, and who underwent 2-wall decompression, suffered visual loss. Conclusion: Early surgery to address progressive sensory disturbances is recommended so as to avoid the hazards of late-stage decompression. The risks of surgery must be weighed against the benefits of achieving a more functional and aesthetic result. Long-term neuro-ophthalmologic monitoring is essential. © 2001 American Association of Oral and Maxillofacial Surgeons

Coralline hydroxyapatite sphere in orbit restoration.

To restore the anophthalmic socket, primarily or secondarily, using a hydroxy-apatite sphere (HA). We used HA in 33 patients (25 male, 8 female), aged from 4 to 68 years (mean 38.1 years) for 19 primary and 14 secondary implantations. HA spheres measured 16 mm in one patient, 18 mm in 21 and 20 mm in 11. The spheres were wrapped in donor sclera preserved in absolute alcohol. All six extraocular muscles were isolated, in the cases where this was possible. Buccal membrane was grafted in three patients to restore the fornices. Drilling was done on four patients using a 3.8 serrated plastic sheath. During follow-up of 7-69 months we observed no complications except for slight edema in the immediate postoperative period. All patients gained very good to excellent motility of the implant, acceptable symmetric appearance in the case of primary implantation, and a dramatic improvement of facial appearance in the case of secondary implantation. HA spheres are an excellent orbital implant for primary and secondary restoration of the anophthalmic socket causing no serious complications.

Social perceptions of the effects of Down syndrome facial surgery: a school-based study of ratings by normal adolescents.

This study examines how 277 normal adolescents from five Israeli schools perceive the Down syndrome face before and after plastic surgery. A seven-point Likert scale was used to rate slides of normal and Down syndrome faces on four dimensions. Down syndrome patients were seen as less attractive, intelligent, good-hearted, and socially appealing than normal individuals. The slides were in nonapparent order and contained preoperative and 1-year postoperative views of eight plastic surgical patients. Paired t tests were used to examine operative changes, and all four dimensions showed overall postoperative improvement (p less than 0.001), but case-to-case variation was considerable. A linear relationship was found between change in appearance ratings and change in intelligence ratings. Findings suggest that when improvements in facial appearance are realized, peer normal social perceptions of the Down syndrome child may be enhanced. The relationship between school placement, intellectual level, and surgical decision making is discussed.

面接調査による下顎前突症手術希望患者の心理社会的検討 ＩＩ 術後調査

We have investigated the psychosocial aspects of 55 mandibular prognathism patients, 20 males and 35 females, for a period of one year after their operations, by interview based upon our own questionnaire.1) For many patients, the intermaxillar fixation was considered to be the most uncomfortable procedure during the mandibular prognathism treatment.2) 80% of the males and 78% of the females showed improved mastication after the surgical procedure.3) Only 21% of the subjects had difficulty in pronunciation after the surgery. An improvement in pronunciation was achieved in 35% of the males and 48% of the females.4) The evaluation, by means of sliding scales, showed that the majority of the postoperation subjects inclined to regard their deformity as slight or none, and their facial appearance no longer suffered.5) The 38% of the male patients attached great importance to the improvement of mastication after surgery. And the improvement of feeling, appearence, pronunciation followed. For the female patients, 55% took the improvement of facial appearance as most important. And the imporovement of mastication, feeling, and pronunciation followed.6) 6% of the male and 30% of the females showed positive changes in their individual and social life-style after the operation. We did not find out behavioral problems among the patients.7) 65% of the males and 77%of the females had no or only slight self-consciousness after surgery.8) 80% of the males and 85% of the females showed a high degree of satisfaction with the results of the operation. Some patients showed a slight dissatisfaction with their facial appearence and complications after surgery.

Lower premolar extraction/removable plastic Herbst treatment for mandibular retrognathia

The patient was a 12-year-old girl with a Class I malocclusion characterized by maxillary arch width constriction, dental crowding, and mandibular retrognathia. Treatment goals related to the chief complaint were anterior mandibular repositioning, maxillary arch expansion, and dental alignment. Because the preexisting overjet was minimal and prevented adequate anterior repositioning of the mandible, lower first premolar extraction was recommended to increase the overjet and allow greater anterior repositioning. Treatment was divided into four stages: (1) extraction of mandibular first premolar teeth, alignment, space closure, and an increase in the overjet, (2) anterior mandibular repositioning with a removable plastic Herbst appliance, (3) arch alignment and detailing of the occlusion with full fixed appliances and a tooth positioner, and (4) retainers. At the end of treatment, the patient had an acceptable dental alignment with a Class III molar relationship and an improvement in facial appearance.

Surgical-orthodontic correction of vertical maxillary excess

Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontist's desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appearance and the predictability and stability of the results have made this a most versatile and effective procedure when carried out with good planning, proper execution and attention to detail.

Surgical-orthodontic correction of open-bite deformity

The combined simultaneous anterior and posterior maxillary ostectomy has proved to be a useful method of treating skeletal open-bite. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower-face height, contour-deficient chin, and Class II malocclusion. Primary contraindications are the Class III skeletal open-bite and lip competence. We have used the procedure as routine treatment for many open-bites over the past 5 years since we first described it. Clinically, the results have been most gratifying, with marked improvement in facial appearance and stability of the open-bite correction. A preliminary study of stability following this procedure indicated good stability with regard to the vertical repositioning of the maxillary segments. A recently completed study by us on thirty-two patients treated with this procedure and followed for an average of 1.5 years showed excellent stability. This is by no means the only method by which open-bite may be successfully treated, but it is one more method to add to our armamentarium. The surgical procedure must be carefully planned and executed to attain the best possible results. Furthermore, the orthodontic procedures, particularly those involving vertical forces, must be provided at the proper time so that the surgical results are not compromised. Nevertheless, with proper planning, attention to detail, and meticulous execution, the results are rewarding.

Traumatic ossification around the temporomandibular joint the use of a stainless steel prosthesis

A review of fourteen patients with “ankylosis” of the temporomandibular joint reveals that in the majority the condition results from indirect trauma to the chin sustained around 5 years of age. The so-called “ankylosis” in this series was result of a large amount of extra-articular bone formation around the joint. The injury also interferes with the growth of the mandible, there being a greater effect upon the growth of the ascending ramus, leading to dental malocclusions, facial deformity and sometimes airway obstruction. The results are presented of an osteotomy of the ascending ramus, followed by insertion of a stainless steel prosthesis into the lower fragment carried out in all these fourteen patients. A new joint is formed, with improvement of facial appearance and correction of dental occlusion.

The Influence of the Upper Incisor Position on Soft Tissue Facial Profile

Facial proportions are important from an aesthetic point of view in that to be harmonious the upper, middle and lower face need to be of approximately equal size.The object of this study is to determine changes in hard and soft tissue profile which occur in patients having a Class II, Division 1 type incisor relationship as a result of overjet reduction.Thirty-three patients were studied cephalometrically there being an average overjet of 6·99 mm at commencement of treatment which reduced to an average of 3·5 mm on final analysis.Clinical appraisal suggests that there was an improvement of facial appearance following treatment. Cephalometric analysis shows that subnasale, labrale superius and labrale inferius moved nearer to the facial Plane as a result of re-modelling of the hard tissues resulting from orthodontic treatment.The female patients showed a relationship between retraction of the upper incisors and reduction in prominence of the lower lip and in those having a Class I dental base relationship,...