Improvement Of Facial Asymmetry Research Articles

Suture Cheek Suspension Augments Periorbital Aesthetic Rehabilitation in Facial Nerve Palsy

Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.

Surgical Orthodontic Treatment for Skeletal Class I with Facial Asymmetry and Occlusal Cant: A Case Report

Background: Cases of facial asymmetry with chin deviation and canted occlusal plane represent a challenge in orthodontic treatment. Case Report: We report successful surgical orthodontic treatment for skeletal Class I with severe facial asymmetry. Miniscrew anchorage was used to decompensate the canted occlusal plane in presurgical orthodontic treatment with a fixed appliance by the intrusion of the maxillary right molars and extrusion of the left molars. Then, orthognathic surgery consisting of bilateral sagittal split osteotomy for asymmetric mandibular setback was performed. Treatment resulted in marked improvement of facial asymmetry. Conclusion: The use of miniscrew implant anchorage may represent a superior presurgical orthodontic treatment and expand the possibility of treatment by one-jaw surgery.

Does no-intraoperative correction of chin deviation prevent costochondral graft overgrowth in pediatric temporomandibular joint ankylosis management - an intermediate outcome study

The use of costochondral graft is controversial for pediatric temporomandibular joint reconstruction due to its unpredictable growth. The height of the cartilage is directly responsible for the growth capacity of costochondral graft. Even after keeping the cartilage in costochondral graft to a recommended height, overgrowth has been reported. Traditionally during costochondral graft fixation, chin deviation is corrected intraoperatively. The investigators hypothesized that this intraoperative manipulation of mandible to correct chin deviation and maintaining the chin in new position causes excessive stress and strain in the muscular functional matrix. The authors believe that this may be the reason for excessive growth trigger on the grafted side. This study intends to prove the hypothesis of no-intraoperative correction of chin deviation can prevent overgrowth of the costochondral graft. We implied this technique in pediatric temporomandibular joint ankylosis patients managed with osteoarthrectomy and reconstructed with costochondral graft. Patients with at least a follow-up of 30-months were included in the study. The study sample consisted of 20 patients. All the patients had adequate growth with improvement in facial asymmetry. The results of the present study supports our hypothesis of no-intraoperative correction of chin deviation as a technique to prevent overgrowth of costochondral graft. We recommend this technique to allow catch-up of growth rather than acceleration of growth. This change in technique needs more research, randomized controlled trial for reliability and long-term results.

Clinical application of a 3-dimensional morphometric apparatus for diagnosis and treatment of a Class III patient with facial asymmetry: A pilot study

This article demonstrated the usefulness of a non-contact 3-dimensional (3D) morphometric apparatus in orthodontic diagnosis and treatment evaluation. A female patient, 23 years 6 months of age, had a Class III malocclusion with mandibular deviation. The 3D images taken by a 3D morphometric apparatus figured out her protrusive chin of 6mm on the deviation side compared to the non-deviation side, and showed a possibility of orthognathic surgery. Before starting of orthodontic treatment, a diagnostic splint was used for 2 months to determine her proper mandibular position. The 3D images retaken for quantitative evaluation showed decrease of the mandibular protrusion by approximately 3mm, and improvement of facial asymmetry. Then, we decided to treat the patient without orthognathic surgery. After 18 months of active orthodontic treatment with miniscrew anchorage, the mandibular deviation was improved and an acceptable occlusion was achieved. The 3D images at posttreatment demonstrated significant decrease of chin protrusion on the deviation side, and improvement of facial asymmetry. In conclusion, a 3D morphometric apparatus could provide quantitative data of facial asymmetry and chin protrusion and contributed decision making process of treatment planning in a patient with facial asymmetry.

Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia

We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky’s type II classification ( Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment—especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored.

Effect of Acupuncture in a Patient with 7-Year-History of Bell's Palsy

To demonstrate the effect of acupuncture in a child with chronic Bell's palsy of 7 years duration. A 15-year-old girl had Bell's palsy for 7 years and did not respond to steroid treatment in the acute phase. On examination, her eyes were asymmetric, with the right eye smaller. Muscle contracture was noted around the right nasalis. She had synkinesis (i.e., when she blinked, there was involuntary twitching of her mouth at the right side). She showed marked facial distortion when puffing out cheeks, smiling, and raising her eyebrows. The tip of her tongue was swollen with red spikes. House-Brackmann facial nerve grading system (HBS) before treatment was grade 4. Patient was given 25 acupuncture treatment sessions in 2 months. Local acupuncture points used were: LI20, ST2, ST3, ST4, ST6, ST7, SI18, BL2, TE17, TE23, GB14, GV26, CV24, EX-HN5, and EX-HN16; distant points used were: LI11, ST36, ST40, SP6, SP10, HT8, SI3, BL67, PC8, TE5, and LR3. About 10 points were selected from the above set in each session with needles inserted to elicit the de qi response. The patient was asked to report any change in muscle strength or any differences noted after each acupuncture session. Photographs and videos were taken for blind assessors to comment on. The patient rated an overall improvement of 60-70%. Self-perceived muscle strength when smiling and puffing out cheeks increased from 20% of normal strength to 65%, and the strength when raising eyebrows increased from 10% to 70%. Synkinesis was attenuated. Photographs and videos showed improvement in facial asymmetry. HBS changed to grade 3 after treatment. Our study showed that acupuncture can be effective in improving functional and cosmetic outcome even for chronic Bell's palsy.

Surgical management of facial vascular anomalies: role of intraoperative seventh nerve monitoring

Surgical management of facial hemangiomas, the most common childhood neoplasms and infiltrating facial vascular malformations, has the risk of injury to the facial nerve and remains controversial. The aim of this study was to analyze the use of the commercially available Neurosign 100® Nerve Monitor in those cases of facial vascular anomalies where resection was considered the appropriate treatment. On a prospective basis, six consecutive patients with deep (so-called infiltrating) vascular anomalies of the face (two hemangiomas, three lymphatic malformation, one lymphatico-venous malformation) were enrolled in this study. During surgical preparation, electromyographic (EMG) activity of the muscles innervated by the facial nerve was monitored. The variables collected included the patient’s sex, age at surgery, location of the lesion and depth, prior treatment, diagnostic workup, site of skin incision, operating time, operative and postoperative complications, and reconstructive outcome. All lesions were resected without major bleeding. Postoperatively, all patients showed regular, symmetrical function of the facial nerve. The mean operating time was 136.7 min (range 90 to 240 min). During the preparation using surgical instruments, EMG activity was noted both as a graphic signal showing facial nerve activity and as an acoustic signal. In all patients, the branches of the facial nerve were identified clinically by electrode stimulation at 30 Hz. Postoperatively, all patients had improvement of facial asymmetry and deformity; preoperative pain episodes and functional impairments resolved completely. Intraoperative facial nerve monitoring provides feedback regarding the location, extent, and ongoing functional status of the facial nerve in the surgical management of infiltrating benign lesions such as hemangiomas and vascular malformations. Besides an overall distinct indication for surgery, we recommend its use for prevention of iatrogenic facial nerve injury.

Mandibular lengthening by gradual distraction in humans

The purpose of this study was to evaluate human mandibular lengthening by gradual distraction. The operation was performed under nasoendotracheal anesthesia. After exposing the angle of the mandible through an intraoral incision, two half-pins were inserted on each side of the corticotomy line. Following this, a corticotomy was performed using a sagittal saw, and the mandible was gently fractured. The external bone lengthening device was applied leaving a bone gap of 3 mm. Serial distraction of 1 mm per day was started on the 10th postoperative day. The device was left in place for retention purposes for 9–11 weeks. Three patients (average age 10 years and 3 months) underwent this procedure. The distraction achieved was 19 mm. Postoperatively, improvement of facial asymmetry and increased volume and length of the mandible were noted without any perioperative complications. The follow-up period averaged 13 months. These results suggested that this procedure is beneficial for the treatment of craniofacial microsomia.

Improvement of facial asymmetry with eye glasses

The appearance of cosmetic deformities of the orbit can be improved by eye glasses. These optical methods can improve the final outcome after orbital or facial reconstructive surgery. Patients with vertical displacement of one globe, enophthalmos or microphthalmos, and buphthalmos may benefit if the eye is amblyopic or blind.

下顎前突症手術患者の顔面非対称性の評価について 数量的評価と感覚的評価の対応に関する実験的検討

The relationship between subjective and objective evaluation of facial asymmetry of mandibular prognathism patients shown by photographs, was investigated. Seven parts of measuring distances and angles representing facial asymmetry were selected in the first experiment and six for the second experiment.The parts of the face include: the distance from the median line of the face to point A, B, Ch and Al of right and left sides, angle ABC of right and left sides, angle OBC of right and left sides, and the right and left sides of the chin (Me) as shown in the diagram of a mandibular prognathism patient. The two results are as follow:1) The evaluation by the oral surgeons in our department, using multiple regression analysis, showed that the more the asymmetry in the region of the mandibular angle was severe, the more the facial asymmetry was felt to be severe. On the other hand, the result obtained from a questionnaire, distributed at the same time to the same subjects showed the chin to be most important for realizing facial symmetry. Therefore oral surgeons are inclined to pay too much attention to asymmetry of the chin region.2) Multiple regression analysis shows, for oral surgeons and the public, that the postoperative improvement of facial asymmetry is most closely related to the improvement of the symmetry of the mandibular angle region. However, 57.5% of oral surgeons, on the questionnaire, regarded the asymmetry of the chin region as most important in evaluating the asymmetry of the face. The percentage indicating the mandibular angle was only 20%. This was remarkably different from the 60% of the public. Together the multiple regression analysis and questionnaire results coincide, and they suggest that the mandibular angle is the most important part in judging the asymmetry of the face.

Long-term Results of Operative Treatment of Congenital Muscular Torticollis

We reviewed 29 cases of the congenital muscular torticollis which had been treated by open tenotomy during the period of 1956-1972 in our clinic and evaluated by direct examination in 1978.The treatment consisted of open tenotomy, immobilization in plaster brace to maintain the overcorrected position for 3 to 4 weeks and physical therapy etc.The following conclusion was drawn.1) Facial asymmetry was improved satisfactorily when the operation was done before 2 years of age.2) Correlation between improvement of facial asymmetry and that of rotatory motion of the neck was suspected.3) In majority of cases the contour of the sternocleidomastoid muscle of the operated side located more laterally than that of the contralateral side.4) The scar of the skin incision had tendency to move upward. Therefore, we think it had better to make the incision at the inferior margin of the clavicle.5) Cause of the residural wry neck was mainly incomplete resection of the muscles.