Infraorbital Area Research Articles

Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series.

As nonsurgical rejuvenation with fillers continues to grow in popularity, patients are increasingly interested in more durable results. Polymethylmethacrylate (PMMA)-collagen gel is unique among fillers in that the PMMA microspheres are not completely absorbed and phagocytosed by the body. This durability coupled with the biophysical properties of PMMA makes it a poor choice for periorbital rejuvenation, an unforgiving and highly complex anatomic area. Between 2011 and 2018, 14 patients with PMMA granulomas in various facial areas self-referred to the senior author's practice. Of these patients, 11 were managed nonsurgically; however, all 3 patients who presented with granulomas in the infraorbital area required surgery to remove the filler and restore a natural aesthetic. The 3 patients with significant swelling and PMMA filler nodules in the infraorbital area with unacceptable cosmetic appearance were females between the ages of 50 and 55 years. Nonsurgical protocols were unsuccessful, and surgical removal was required. All subjects have been followed for a minimum of 2 years with no immediate- or long-term postoperative complications secondary to PMMA removal. Patients remain satisfied with the outcome of the surgery. Despite the evidence that the periorbital area is prone to adverse events when injected with particulate fillers, misguided enthusiasm for PMMA-collagen gel as a durable treatment continues to lead to unnecessary and severe complications in patients. The case studies presented here highlight that this product should not be introduced into the periorbital area. We also describe a surgical treatment approach for its removal if complications arise.

Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures.

To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

Limited eye movement caused by clumping of fibrin glue used in blowout fracture surgery: a care report

Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient's symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.

Facial Defects With Infraorbital and Zygomatic Area Reconstruction Using an Expanded Flap Based on the Orbicularis Oculi Muscle: A Long-Term Follow-up.

Reconstruction of facial soft-tissue defects may pose a dilemma for plastic surgeons, as the flaps must be reliable to obtain a natural appearance while minimizing donor site morbidities. This clinical study describes a reconstructive method for infraorbital and zygomatic defects using a pre-expanded rotation flap based on the orbicularis oculi muscle (OOM). The surgeries were subdivided into 2 stages. In the first stage of the operation, a 100 to 200mL expander was placed underneath the temporal area through a hairline incision. In the second stage, after adequate inflation of the expander, the pre-expanded rotation flap based on the OOM of the lower eyelid was raised from lateral to medial to cover the facial defects. In this single-center study from February 2010 to February 2017, 16 patients underwent facial defect reconstruction using the pre-expanded flap based on the OOM. All of the defects were located at the infraorbital and zygomatic regions, and their sizes ranged from 3.0 4.0 to 7.0 14.0cm. The causes of these defects included postburn scars (37.5%), melanocytic nevus (50%), and hemangiomas (12.5%). In all cases, good coverage was provided for the defects that were in the medial cheek or lower eyelids. There were no flap losses of any kind. There were no major complications, and all minor incidences were treated by minimal procedures. The patients were followed up after surgery, with the follow up ranging from 6 months to 108 months. The follow-up data included postoperative consultations, the defect size, the need for further procedures and the degree of satisfaction. The pre-expanded rotation flaps in the lateral facial area based on the OOM can ideally and safely be applied for facial defect reconstruction owing to their reliable blood supply and excellent texture match.

Intraoral Approach to Fat Grafting Based on the Mimetic Muscle Unit.

Recently, the concepts of anatomic-based fat grafting and mid-facial anatomy have been studied. However, there is no clear consensus on the optimal fat grafting technique. We aimed to introduce a novel intraoral approach to fat grafting based on mid-facial mimetic muscles, wherein a substantial amount of fat was injected into appropriate locations to increase patient satisfaction and decrease the need for additional surgical techniques. Sixty-four Asian women (mean age, 41.2 y) who had undergone fat grafting through the intraoral approach between 2014 and 2019 were enrolled. We sequentially performed the following steps: fat harvesting, centrifugation, and fat injection. All patients were followed at an outpatient clinic for 6 to 12 months. We obtained photographs of their face before and at 3 and 6 months postoperatively and conducted a 5-point scale questionnaire survey at the 2 time points postoperatively to evaluate the satisfaction of patients and surgeons. We divided the mid-facial areas into malar eminence, infraorbital, and nasolabial fold areas and evaluated the following items: volume consistency, softness, irregularity, and overall satisfaction. Patients reported "satisfactory" for the postoperative results. There were only 2 cases of complication among the 64 cases which resolved spontaneously. The highest and lowest satisfaction were reported for the malar eminence and nasolabial fold areas, respectively. Fat grafting through the intraoral approach based on the mimetic muscle unit is an effective and safe method for mid-facial rejuvenation.

Effect of Positional Changes on Skin Landmarks in Midface Filling.

The design lines for midfacial filling shift upward with a patient's position changes from upright to supine during operation. This will cause the actual filled part to deviate from the target area. This authors aimed to evaluate the effect of positional changes on midfacial landmarks and find the optimal body position for midface filling. The process involved the grading and evaluation stages. The midfacial laxity of each sample in the evaluation stage was graded into minimal, moderate, and severe by the system established in the grading stage. Measured through the 3-dimensional images in each grade, the vertical distances from landmarks C, D, and E (representing the region of the tear trough, infraorbital area, and nasolabial fat pad, respectively) to the horizontal line of the inner canthus and depth of nasolabial fold at an angle of 90° were separately compared with those from the other angles (60°, 45°, 30°, and 0°) of the operating table. In the minimal midfacial laxity group, all 3 landmarks significantly moved upward when the angle decreased to 30°. However, landmark E of the moderate and severe and landmark D of the severe midfacial laxity groups both significantly moved upward when the angle decreased to 45°. The depth of the nasolabial fold at a 45° angle was significantly less than that at a 90° angle in the moderate and severe groups. In midface filling, a patient's body position should be optimally selected according to the midfacial laxity and filling area.

The role of autophagy on eye migration during the metamorphosis of Paralichthys olivaceus.

The metamorphosis of flatfish is unique, especially its eye migration. Autophagy has been found to be involved in a variety of organisms' metamorphosis. In order to explore the relationship between autophagy and flatfish metamorphosis, we investigated the expression of autophagy marker gene lc3b during the metamorphosis using real-time quantitative polymerase chain reaction and in situ RNA hybridization. Besides, we inhibited cell division, which was reported as the force source of eye migration, and autophagy around the mobile eye by microinjecting the inhibitors to explore the effects on autophagy expression and eye migration. We found that autophagy taking place during the metamorphosis, particularly in the areas around the eyes. In addition, the eye migration could be blocked by inhibiting the autophagy in the supraorbital area of the blind side, and after we blocked the eye migration by inhibiting cell proliferation in the infraorbital area of the blind side, the autophagy around the eye was partially inhibited. These findings indicate that the autophagy around the eyes caused by eye migration. Moreover, the cell death caused by autophagy loosen the orbital tissue to create space for the eye migration.

Infraorbital Hyaluronic Acid Filler: Common Aesthetic Side Effects With Treatment and Prevention Options.

BackgroundInfraorbital hollows can give a fatigued or aged appearance, which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects (SEs) from this treatment are very common. While some patients are clear surgical candidates vs filler candidates, in real-world practice, many, if not most, patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs benefit profile.ObjectivesCommon aesthetic SEs from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment.MethodsThe author’s experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short- and long-term follow-ups over 8 years is leveraged to provide detailed guidance.ResultsRecommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially).ConclusionsFor nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in the management of SEs to increase patient satisfaction with their treatment and aesthetic outcome.Level of Evidence: 5

Two versus five bilateral local anesthetic injections for submucosal resection

Background Submucous resection (SMR) is performed under general anesthesia, local anesthesia, or a combination of both. The combination was associated with less postoperative pain and shorter hospital stay. The purpose of this clinical trial was to compare the effectiveness of two versus five bilateral local anesthetic injections in terms of postoperative pain relief at 24 h postoperatively. Patients and methods This was a prospective, randomized, double-blind clinical trial conducted at a tertiary care center between May 2015 and December 2016. Patients aged between 15 and 63 years scheduled for elective SMR of the nasal septum were included. Eligible patients received general anesthesia and were randomly assigned to receive either two or five bilateral local anesthetic injections. The primary outcome was pain assessed by the Numeric Rating Scale. Other outcomes were hemodynamic stability, analgesic consumption, nausea and vomiting, as well as patient’s and surgeon’s satisfaction. Results A total of 120 patients were included in the study and were divided equally into the two groups. Both groups were similar in terms of age, height, weight, surgery duration, and hemodynamic characteristics. There was no significant difference for both groups in pain scores at 24 h (1.53±1.25 vs. 2.07±1.82, P=0.069 for two vs. five injections, respectively) and over the 10 postoperative days. Similarly, the number of patients who consumed analgesics was similar between the two groups. Conclusion The present study revealed that two bilateral local anesthetic injections at the suprazygomatic and infraorbital areas could be an alternative to five injections in patients undergoing SMR.

Localized surgical debridement for the management of orbital mucormycosis.

Purpose:To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration.Methods:The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months.Results:The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication.Conclusion:Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.

A Double-Blind, Split-Face, Randomized Study on the Effects and Safety of Intradermal Injection of Botulinum Toxin A (Incobotulinum Toxin A) in the Cheek.

Intradermal injection of botulinum toxin A (BTXA) is used for cosmetic purposes without strong evidence for clinical use, as opposed to intramuscular injection. To evaluate the efficacy and safety of intradermal injection of incobotulinum toxin A (iBTXA) in the cheeks. We conducted a study with 18 volunteers who received intradermal injection of iBTXA into one cheek and normal saline into the contralateral side as a control. Volunteers visited the clinic at weeks 2, 4, 8, and 12 after injection. At each visit, pores and wrinkles were evaluated by a facial analyzer, sebum secretion by a sebumeter, skin texture by both volunteers and clinicians, and wrinkles of the nasolabial fold were graded with photographic reviews. There were no significant effects on the wrinkles of the infraorbital area and sebum secretion. However, there were significant improvements in the wrinkles of the nasolabial fold and skin texture on the iBTXA injected side. The effects on the wrinkles of the nasolabial fold lasted 12 weeks, and those on skin texture lasted 8 weeks. Improvement in the pore size was observed only at week 2. No serious adverse events were reported except one volunteer who complained of facial palsy after the injection of 30 units of iBTXA in one cheek. However, injection of 20 units of iBTXA in one cheek was not associated with any adverse events. Intradermal injection of iBTXA, could provide clinical benefits for skin texture and wrinkles overcoming the skin prick effect without obvious side effects.

Adipose Collagen Fragment: A Novel Adipose-Derived Extracellular Matrix Concentrate for Skin Filling.

Skin filler is an option for treating skin aging and wrinkles; however, currently used fillers are limited by poor biocompatibility, rapid degradation, and possible hypersensitivity reactions. Autologous adipose tissue-derived products have been recognized as promising options for skin rejuvenation. This study aimed to develop a novel adipose-derived product for skin filling. Adipose collagen fragment (ACF) was prepared through pulverization, filtration, and centrifugation. The macrography, structure, types of collagen, and cell viability of ACF were evaluated by immunostaining, western blotting, and cell culture assays. ACF, nanofat, and phosphate-buffered saline (9 spots/side, 0.01 mL/spot) were intradermally injected in the dorsal skin of 36 female BALB/c nude mice; the skin filling capacity and the collagen remodeling process were then investigated. Twenty-one female patients with fine rhytides in the infraorbital areas were enrolled and received clinical applications of ACF treatment. Therapeutic effects and patients' satisfaction scores were recorded. The mean [standard deviation] yield of ACF from 50 mL of Coleman fat was 4.91 [0.25] mL. ACF contained nonviable cells and high levels of collagen I, collagen IV, and laminin. Fibroblasts and procollagen significantly increased in ACF and ACF-treated dermis (P < 0.05). Overall, 85.7% of patients were satisfied with the therapy results, and no infections, injection site nodules, or other unwanted side effects were observed. ACF significantly improved dermal thickness and collagen synthesis and may serve as a potential autologous skin filler.

A patient with diffuse oedema of the eyelids, infraorbital area and indurated plaques over the scalp.

A patient with diffuse oedema of the eyelids, infraorbital area and indurated plaques over the scalp.

Results of treatment of patients with midfacial fractures

Background. Fractures of the bones of the facial skeleton, in particular the midface area, are one of the most frequent reasons for patients to apply to maxillofacial inpatient care, not only in Ukraine but also abroad. Along with more modern treatment technologies (osteosynthesis using titanium miniplates and minigrid for fixation bone fragments), methods of repositioning of fragments with subsequent tamponade of the maxillary sinus with iodoform tampon and without tamponade and fixation of fragments are used. A certain group of patients is treated conservatively, which is associated with their reluctance to undergo surgery, minimal displacement of fragments or minimal cosmetic and functional impairments. The purpose of the study. Comparative evaluation of the results of treatment of patients with fractures of the midface area by repositioning the fragments of the zygomatic-orbital complex without fixating the fragments and their subsequent fixation by tamponade of the maxillary sinus with iodoform tampon. Object and methods of research. The comparison was made of the results of treatment of 70 patients with fractures of the midface area, among which 13 patients were treated by the method of repositioning fragments of the zygomatic-orbital complex (ZOC) without fixation and without maxillary sinus tamponade, 29 patients underwent repositioning of ZOC fragments with subsequent fixation of fragments with iodoform tampon – the tamponade of the maxillary sinus was performed on the affected side. For comparison, the results of conservative treatment of 28 patients with fractures of the midface area were used. Results. It was found that the reliable (χ2=11.43; p&lt;0.05) majority of patients (64%) sought treatment within 0-3 days after injury. 83-89% of patients who underwent repositioning of the fragments had fresh small-fragment fractures. The reliable (χ2=11.43; p&lt;0.05) majority of them simultaneously had 3-4 sites of bone fractures of the midfacearea, hemosinus of varying degrees and paresthesia in the infraorbital area. In the majority of patients who underwent repositioning of bone fragments with and without tamponade (85% and 93%, respectively), the final displacements ranged from 3.1 to 6 mm. In patients treated conservatively, in most cases (93%) the displacements were greater than 3.1 mm, which remained after treatment. Conclusion. In the majority of patients treated with the studied methods, in the long term, the displacement of bone fragments remained, which had functional and cosmetic consequences. In all studied groups, a certain cosmetic effect was achieved over time, as evidenced by a reliable (χ2=160.9; p=0.00000) decrease in the indicator by the visual analogue scale .

Система підтримки прийняття рішень лікарем щодо вибору методу лікування переломів середньої зони обличчя

The purpose of the study is to develop a support system of doctor’s decision-making on the choice of a method for treating fractures of the midface are. Materials and methods. The study includes the results of examination and treatment of 112 patients with fractures of the midface area, who were undergoing inpatient treatment in the Department of Head and Neck Surgery of the Municipal Noncommercial Enterprise of Kharkiv Regional Council «Regional Clinical Hospital», Kharkiv. All patients at hospitalization underwent examination according to the local protocol. The diagnosis was based on the results of cone-beam computed tomography, or multislice computed tomography. To determine the initial condition, as well as to assess the functional and cosmetic effects in the treatment process (1st, 3rd, 5th and 7th days) a visual analogue scale was used, at hospitalization we also used a visual analogue scale modified by us, which contains a point evaluation of the patient's condition for 12 signs of trauma. The Scilab computer algebra system was used to develop models for predicting the results of treatment of the midface area fractures using various methods, and a graphical application for the Windows operating system was developed for the practical use of the support system of doctor’s decision-making, in which the Sugeno fuzzy inference machine was integrated into the developed models Results and discussion. To predict the displacement of bone fragments that will remain after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment; indicator by the modified visual analogue scale. To predict the indicator on a visual analogue scale a day after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment, the number of plates in the case of metal osteosynthesis, the indicator by a visual analogue scale before surgery. To predict indicators by a visual analogue scale in the subsequent terms, the values of indicators by this scale in the previous terms are added to the input indicators of the model. Conclusion. As a result of the research it was found that the following can be used as the functional and cosmetic results of treatment of the midface area fracture in the development of predicting models: the amount of displacement of bone fragments, which was determined by computed tomography after surgery, and the values of indicators by a visual analogue scale after a day, 3, 5 and 7 days after surgery. The developed models for predicting functional and cosmetic results of treatment as a result of testing using indicators of 112 patients with fractures of the midface area showed an overall accuracy of 91.6%, sensitivity – 95%, specificity –96.4%.

The Evaluation of Efficacy and Safety of A Radiofrequency Hydro-Injector Device for the Skin around the Eye Area.

In recent years, variable rejuvenation techniques, such as hyaluronic acid (HA) fillers and radiofrequency (RF) devices, have become popular. We evaluated the RF hydro-injector (RFHI) device that simultaneously delivers both a microneedle intradermal RF treatment and a HA filler injection to overcome the disadvantages of HA filler and RF devices alone. This study aimed to assess the efficacy and safety of the RFHI device for the rejuvenation of the periorbital area, including the lateral canthal lines (LCLs) and the infraorbital area. A total of 24 subjects were enrolled in this study and underwent 2 to 3 treatments using the RFHI device. The investigator’s global assessment of the lateral canthal line (IGA-LCL) and the global esthetic improvement scale (GAIS) were used to evaluate the improvement in the LCL. Cutometer® was used to evaluate the skin’s elasticity, and the Antera 3D image capture system® was used to evaluate the degree of wrinkles, roughness, and pore volume. At the 8 week follow-up after the first treatment session, both the IGA-LCL and GAIS showed significant improvement. The improvement in the wrinkles, roughness, and pore volume, measured by the Antera 3D image capture system®, was statistically significant. No serious adverse event was reported. This RFHI device, which delivers both microneedle intradermal RF treatment and HA filler injection, is effective and safe for periorbital rejuvenation.

The efficacy and safety of autologous stromal vascular fraction transplantation for infraorbital skin rejuvenation: A clinical prospective study.

The stromal vascular fraction of fat tissue contributes to its rejuvenation properties. The stromal vascular fraction is a minimal processed cell population. Therefore, it is purportedly a suitable cell therapy for skin rejuvenation. This clinical trial aimed to evaluate the efficacy and safety of transplantation of autologous stromal vascular fraction to aging skin in the infraorbital region. Nineteen patients were candidates for stromal vascular fraction isolation and transplantation. They underwent lipoaspiration of the abdomen to obtain samples of fat tissue. The stromal vascular fraction was thereafter harvested and transplanted in each infraorbital area. The patients' outcomes were measured and were based on surface evaluation of wrinkles, surface evaluation of scaliness, and melanin evaluation with a Mexameter. The red blood cell volume and skin elasticity were measured with an erythrometer and cutometer, respectively. Three months and 6months after autologous stromal vascular fraction transplantation, the elasticity, wrinkle, and pigmentation of the infraorbital skin improved significantly, but not surface evaluation of scaliness and erythema. The phenotype also improved in the infraorbital skin area, as evaluated by physicians. The stromal vascular fraction of adipose tissue represents an attractive cell source. In our study, preliminary data showed that clinical outcomes were also generally satisfactory with no serious adverse effects. Thus, stromal vascular fraction cells are safe for clinical rejuvenation use. We encourage future evidence-based controlled studies to maintain a strong focus on the efficacy and safety profile of stromal vascular fraction therapy.

Three-dimensional topography of facial soft tissues for the safer and effective threading procedures.

To reduce complications caused by the procedure, the target layer for thread lifting should be the superficial fat or superficial musculoaponeurotic system of the face. The aim of this study was to establish the thicknesses of the facial skin and superficial fat using a 3D scanning system to provide basic clinical data for thread lifting. Thirty fixed Korean and Thai cadavers (male: 17, female: 13) were used. The depths of the skin and superficial fat were measured using a three dimensional (3D) structured-light scanner. Facial images of both undissected and removed skin and superficial fat were taken with the 3D scanner. The paths from the temple and the front of the tragus to the infraorbital, perioral, cheek, and mental areas were displayed on the 3D image. The thickness along the path was measured by calculating the difference between the undissected and dissected 3D images. The means and standard deviations of thicknesses of the skin and superficial fat were 2.1 ± 0.4 mm and 5.2 ± 1.9 mm in the 11 pathways. The facial skin became thicker going toward the lower aspect of the face from temple to infraorbtial and perioral regions. The thickness of the superficial fat around the marionette line showed the biggest change. The present findings indicate that a 3D scanning system can yield crucial anatomical information about the thickness of the facial skin and superficial fat for use in various minimally invasive clinical procedures including thread lifting.

Blink reflex changes and sensory perception in infraorbital nerve-innervated areas following zygomaticomaxillary complex fractures.

BackgroundInfraorbital nerve dysfunction is commonly reported after zygomaticomaxillary complex fractures. We evaluated sensory changes in four designated areas (eyelid, nose, zygoma, and lip) innervated by the infraorbital nerve. This evaluation was conducted using the static two-point discrimination test and the vibration threshold test. We assessed the diagnostic significance of the blink reflex in patients with infraorbital nerve dysfunction.MethodsThis study included 18 patients, all of whom complained of some degree of infraorbital nerve dysfunction preoperatively. A visual analog scale, the infraorbital blink reflex, static two-point discrimination, and the vibration threshold were assessed preoperatively, at 1 month postoperatively (T1), and at a final follow-up that took place at least 4 months postoperatively (T4). The results were analyzed using a multilevel generalized linear mixed model.ResultsScores on the visual analog scale significantly improved at T1 and T4. The infraorbital blink reflex significantly improved at T4. Visual analog scale scores improved more rapidly than the infraorbital blink reflex. Two-point discrimination significantly improved in all areas at T4, and the vibration perception threshold significantly improved in the eyelid at T4.ConclusionsRecovery of the infraorbital blink reflex reflected the recovery of infraorbital nerve dysfunction. We also determined that the lip tended to recover later than the other areas innervated by the infraorbital nerve.

LARGE SCHWANNOMA IN THE MIDDLE THIRD OF THE FACE: A CASE REPORT

The patient presented at the buccomaxillofacial surgery department, reporting that 8 months earlier he had noticed a slow growing and asymptomatic lump on the face. At the extra-oral physical examination, the increase in volume in the left zygomatic, infraorbital, and paranasal area was observed. The intra-oral examination showed hardened consistency tumor, which was painless to the touch, in the area of the hard palate and maxillary vestibule bottom, with normal-colored mucous membranes. At the tomographic exam, the presence was observed of a mixed image of approximately 8 cm in its largest diameter, with defined boundaries, located in the left middle third of the face. An incisional biopsy was carried out, in which the histopathologic analysis was schwannoma. Therefore, the proposed treatment was the aggressive excision of the lesion. The patient has been in the second postoperative year now, showing good evolution without any sign of recurrence.