Nasolabial Region Research Articles

Abstract: 15.20 Revisited Fascia Lata In Facial Palsy

INTRODUCTION: Fascia lata suspension for static surgical treatment of the nasolabial region in long-standing facial paralysis is well established. The objective of this study was to evaluate, from a retrospective viewpoint, the functional and cosmetic effectiveness of static suspension in facial paralysis by introducing a new way to insert the fascial graft in patients with different indications, such as: onset of paralysis, age, general conditions, etiopathogenesis, expectations, and combination with reanimation procedures. We considered the stability, in time, of the results of this ancillary procedure present in every facial reconstructive surgeonÕs armamentarium, and we thought it should be re-evaluated and utilized either alone or in combination with techniques that reanimate the paralyzed face. MATERIALS AND METHODS: In our series, 55 patients with facial paralysis underwent static suspension with fascia lata, advanced in the same fashion as the temporalis muscle in Labbé’s myoplasty, between February 2009 and November 2015. The surgical technique is reported together with preoperative and postoperative records (photographs and videos reviewed for feasibility of the technique), symmetry, aesthetic results. Complications, need for further minor revisions, patients degree of satisfaction and role in improvement of the facial reanimation techniques were also considered. RESULTS: In all the patients the procedure was uneventful and none developed surgery-related complications, including donor-site problems. During follow-up, all the patients achieved improved symmetry at rest and showed satisfaction. The cosmetic outcome was satisfactory, too. Eight patients needed small revision in local anaesthesia. CONCLUSIONS: The results show immediate, aesthetic, stable in time improvement, thus confirming this method as a simple technique for static restoration in patients who have lost any functional reconstructive possibility. The method also works in patients who underwent facial reanimation requiring slight aesthetic improvement. The application of the modified technique has led to a new appraisal and re-evaluation of an almost obsolete method.

Three-layer reconstruction of lower third nasal defects using forehead flap, reversed nasolabial flap, and auricular cartilage

The reconstruction of a full-thickness defect of the distal third of the nose requires the restoration of all three anatomical layers. A practical method for three-layer reconstruction of the lower third of the nose and the long-term results of this technique are presented herein. A combined reconstruction technique was utilized, including a reverse subcutaneous pedicled nasolabial flap to restore the nasal mucosa, an auricular cartilage graft for structural support, and a forehead flap for cutaneous coverage of the defect. This technique was applied in 21 patients following the full-thickness excision of basal cell carcinoma of the lower part of the nose. All patients (12 male and nine female; mean age 59.8 years) were treated successfully and were satisfied with the aesthetic and functional outcomes. The wound had to be further revised in three cases for the correction of contour or residual deformities; however, no further complications were experienced. One patient had a wound infection and the cartilage had to be removed. The grafting procedure was repeated successfully after resolution of the infection. Donor site morbidity was unremarkable. Combined flaps from the forehead and nasolabial regions with an incorporated auricular cartilage graft can be used to reconstruct full-thickness defects of the lower third of the nose.

Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I.

Background:Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I–induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes.Methods:A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P < 0.05).Results:One hundred eight photogrammetric data sets were analyzed, including 46 single-piece, 26 SAME, and 36 segmental. Significant postoperative nasal changes were observed within each intragroup analysis. The most dramatic changes were seen after segmental Le Fort I with advancement and widening, which included alar base width, alar width, nostril width, and soft triangle angle, all P < 0.05.Conclusions:Le Fort I osteotomy results in significant alteration of the nasolabial morphology. This is the first study to 3-dimensionally analyze nasal changes that occur comparing maxillary advancement alone versus widening alone (SAME) versus advancement with widening. These objective data permit improved patient counseling and surgical planning.

Three-dimensional evaluation of the alar cinch suture after Le Fort I osteotomy

Orthognathic surgery has an influence on the overlying soft tissues of the translated bony maxillomandibular complex. Improvements in both function and facial appearance are the goals of surgery. However, unwanted changes to the soft tissues, especially in the nose region, frequently occur. The most common secondary change in the nasolabial region is widening of the alar base. Various surgical techniques have been developed to minimize this effect. The purpose of this study was to evaluate the changes in the nasal region due to orthognathic surgery, especially the alar width and nasal volume, using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Twenty-six patients who underwent a Le Fort I advancement osteotomy between 2006 and 2013 were included. From 2006 to 2010, no alar base cinch sutures were performed. From 2010 onwards, alar base cinch sutures were used. Preoperative and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets, and the alar base width and nose volume were analyzed. No difference in alar base width or nose volume was observed between patients who had undergone an alar cinch and those who had not. Postoperatively the nose widened and the volume increased in both groups.

Histological Changes in Nasolabial Cutaneous Flaps Employed in Intraoral Reconstruction

Nasolabial cutaneous flaps have been routinely used to reconstruct intraoral defects. The purpose of this study was to study histological changes that may occur in the skin flap as a result of its exposure to a new environment. Thirteen patients took part in this study. Fusiform tissue specimens were obtained from the intraoral cutaneous portion of the flap. Biopsy specimens were also taken from the skin of nasolabial region and from the buccal mucosa to serve as control. Thickness of stratum corneum, degree of inflammatory infiltration and number of skin appendages were evaluated. Periodic-acid Schiff (PAS) staining was also performed to identify the presence of hyphae. The characteristic features of the skin are almost always maintained, although the thickness of stratum corneum and the number of skin appendages are often significantly reduced. In two patients the inflammatory infiltration was intense and accompanied by elimination of skin appendages and stratum corneum. These flaps tend to mimic mucosa macroscopically. In four patients fibrosis was histologically demonstrated. These flaps resembled atrophic skin macroscopically. Hyphae could not be identified with PAS staining in this study. Koilocytes, which are indicative of HPV infection, were identified in two flap specimens. Intraorally placed nasolabial flaps may undergo a variety of histological and macroscopical changes. In the majority of cases the intraoral cutaneous flap maintains skin features, except if it becomes heavily infiltrated with inflammatory cells. Inflammation occurs for unknown reasons and results in a mucosa-like microscopic and macroscopic appearance of the intraorally placed flap.

Judgment of Nasolabial Esthetics in Cleft Lip and Palate Is Not Influenced by Overall Facial Attractiveness.

To determine whether judgment of nasolabial esthetics in cleft lip and palate (CLP) is influenced by overall facial attractiveness. Experimental study. University of Bern, Switzerland. Seventy-two fused images (36 of boys, 36 of girls) were constructed. Each image comprised (1) the nasolabial region of a treated child with complete unilateral CLP (UCLP) and (2) the external facial features, i.e., the face with masked nasolabial region, of a noncleft child. Photographs of the nasolabial region of six boys and six girls with UCLP representing a wide range of esthetic outcomes, i.e., from very good to very poor appearance, were randomly chosen from a sample of 60 consecutively treated patients in whom nasolabial esthetics had been rated in a previous study. Photographs of external facial features of six boys and six girls without UCLP with various esthetics were randomly selected from patients' files. Eight lay raters evaluated the fused images using a 100-mm visual analogue scale. Method reliability was assessed by reevaluation of fused images after >1 month. A regression model was used to analyze which elements of facial esthetics influenced the perception of nasolabial appearance. Method reliability was good. A regression analysis demonstrated that only the appearance of the nasolabial area affected the esthetic scores of fused images (coefficient = -11.44; P < .001; R(2) = 0.464). The appearance of the external facial features did not influence perceptions of fused images. Cropping facial images for assessment of nasolabial appearance in CLP seems unnecessary. Instead, esthetic evaluation can be performed on images of full faces.

Submental skin graft: A useful donor site for facial skin defects

Full thickness skin grafts (FTSG) are commonly employed for resurfacing facial reconstruction. Donor sites matching in color and texture are limited to a few facial locations such as the eyelids, pre- and postauricular and nasolabial regions. However, they offer limited amounts of skin and the donor site morbidities are not always well tolerated. On the other hand, submental area provides equally matching skin substance in a comfortably large amount, especially in elderly individuals. We are presenting our experience in 20 patients with reconstruction with submental FTSG’s following facial tumor ablation. Except for one patient, all grafts achieved full take. There were no donor site related complaints; moreover, the patients were very pleased about the submental cervical lifting effect imposed by the technique. Submental region is a suitable FTSG donor side when considering resurfacing facial defects of the elderly female patients and male patients in whom a hair-bearing site needs to be resurfaced.

Pleomorphic Adenoma of the Nasolabial Region

Pleomorphic Adenoma of the Nasolabial Region

Rejuvenation of facial skin and improvement in the dermal architecture by transplantation of autologous stromal vascular fraction: a clinical study.

Introduction: The rejuvenation characteristics of fat tissue grafting has been established for many years. Recently it has been shown that stromal vascular fraction (SVF) of fat tissue contributes to its rejuvenation properties. As the SVF is a minimal processed cell population (based on FDA guidance), therefore it is a suitable cell therapy for skin rejuvenation. This clinical trial was aimed to evaluate the ultrastructural improvement of aging skin in the facial nasolabial region after transplantation of autologous SVF. Methods: Our study was conducted in 16 patients aged between 38 and 56 years old that were interested in face lifting at first. All of the cases underwent the lipoaspiration procedure from the abdomen for sampling of fat tissue. Quickly, the SVF was harvested from 100 mL of harvested fat tissue and then transplanted at dose of 2.0×107 nucleated cells in each nasolabial fold. The changes in the skin were evaluated using Visioface scanner, skin-scanner DUB, Visioline, and Cutometer with multi probe adopter. Results: By administration of autologous SVF, the elasticity and density of skin were improved significantly. There were no changes in the epidermis density in scanner results, but we noticed a significant increase in the dermis density and also its thickness with enrichment in the vascular bed of the hypodermis. The score of Visioface scanner showed slight changes in wrinkle scores. The endothelial cells and mesenchymal progenitors from the SVF were found to chang the architecture of the skin slightly, but there was not obvious phenotypic changes in the nasolabial grooves. Conclusion: The current clinical trial showed the modification of dermis region and its microvascular bed, but no changes in the density of the epidermis. Our data represent the rejuvenation process of facial skin by improving the dermal architecture.

Facialis vírusinokuláció fertőzi a vestibularis és cochlearis agyidegmagokat

Background and purpose – There is growing evidence for the viral origin of the Bell’s facial palsy, vestibular neuritis and sudden sensorineural hearing loss, however their exact pathophysiology is still unknown. We investigated the possibility of brainstem infections following peripheral viral inoculations in rats. Methods – Pseudorabies virus, a commonly used neurotropic viral retrograde tracer was injected into the nasolabial region of rats. Five and 6 days after injections, infected brainstem nuclei were demonstrated by immunohistochemical techniques. Results – Infected neurons were found in the motor facial, the medial vestibular, and the sensory trigeminal nuclei, as well as in the medial nucleus of the trapezoid body. Conclusion – Pseudorabies virus infects auditory and vestibular sensory neurons in the brainstem through facial inoculation. The possible routes of infections: 1. trans-synaptic spread constituted by facio-vestibular anastomoses: primarily infected motor facial neuron infects neurons in the medial vestibular nucleus, 2. via trigeminal sensory nerves: the sensory trigeminal complex innervated by GABAergic medial vestibular neurons, and 3. one bisynaptical route: infected facial motoneurons may receive indirect input from the medial vestibular nucleus and the trapezoid body via connecting neurons in the sensory trigeminal complex. We may assume that latent infections of these areas may precede the infections of the peripheral organs and the reactivation of the virus exerts the symptoms.

Age-related and sex-related changes in the normal soft tissue profile of native Northern Sudanese subjects: a cross-sectional study

Information about age-related and sex-related normative measurements of the nasolabial region in native Northern Sudanese subjects is scanty. We have therefore used a hand-held laser scanner to measure nasolabial angles and distances, and collected the 3-dimensional coordinates of seven landmarks on the facial soft tissues from 654 healthy native Northern Sudanese subjects (327 male and 327 female, aged 4-30 years). From these we calculated five angles and two linear distances and took the mean (SD) for age and sex, and compared them using factorial analysis of variance. All measurements analysed were significantly modified by age in both sexes (p < 0.01) except for the distance from the lower lip to Ricketts’ E-line. Sex had a significant effect on the mentolabial and maxillary prominence angles and both distances (p < 0.005). Nasal convexity and the interlabial angle became more obtuse with growth, while the nasolabial and mentolabial angles reduced progressively with female subjects having significantly more obtuse mentolabial angles (p < 0.001). The maxillary prominence angle progressively decreased during childhood, and increased after adolescence, with larger values in male subjects. The upper and lower lip distances from Ricketts’ E-line were also significantly larger in male subjects (p < 0.003), but the difference reduced with age. Overall, there were several differences when we compared our data with published data for African and white subjects, which points to the need for ethnic-specific data. Measurements collected in the current study could be used for the quantitative description of facial morphology in native Northern Sudanese children, adolescents, and young adults.

Analysis of the complementary measurement of nasogenian wrinkles using Radiocef 2.0® software in the evaluation of facial chronoaging among women of different age groups

Objective : To evaluate the facial aging of women of different ages using a software program to assist in the classification of wrinkles and sagging in the nasogenian region. Method : A descriptive observational study of 100 female volunteers was performed. The women were aged between 20 and 70 years old and were sorted by age group into five groups of 20 volunteers each. The instruments used were the Facial Assessment Protocol, a cephalostat for the standardization of photos, a 14.1 megapixel Sony digital camera, and the Radiocef 2.0® software program. The Kolmogorov-Smirnov (KS) test was used for confirmation of normality and all data was statistically analyzed using ANOVA and Tukey's post hoc analysis. The Chi-squared and Pearson's correlation tests were also performed. A significance level of 5% and a p value of ≤0.05 were adopted. Results : It was observed that all age groups had wrinkles in the nasolabial fold region. There was an association between age and the Goglau, Lapiere and Pierard scale. This incidence increased progressively with aging. A moderate correlation (r=0.67) was observed between age and distance from the nasolabial folds, while angle represented only a weak correlation (r=0.3), with the most significant age group that with the shortest distance and the widest angle. Conclusion : The present study demonstrated the importance of the Radiocef 2.0® software program in providing a more detailed analysis of the nasolabial folds. It is therefore a complementary assessment to the Facial Assessment Protocol, representing a research protocol for identifying the effectiveness of treatments and improving the evaluative procedure.

Myxomatosis in domestic rabbits keeping as pet in Mato Grosso state

In 2011, was admitted to the Veterinary Hospital of the Federal University of MatoGrosso, a rabbit with clinical signs suggestive of myxomatosis, presenting a "leonine face" with nodes scattered throughout the body and blepharoconjunctivitis. With a history of living with other lagomorphs, dogs and cats. The animal died and an autopsy was performed, it was observed macroscopically blepharoconjunctivitis bilateral purulent, eyelids, facial skin, ears and nasolabial region presented with thickened and irregular nodules. On internal examination no changes were observed. Microscopically observed on the skin epidermal layer of the sponge and the formation of small areas marked multifocal pustular and suppurative inflammatory infiltrate at the junction of the epidermis, the dermis. Visualized in the lung is diffuse swelling and sharp, and congestion, thus closing the diagnostic myxomatosis

Facial rejuvenation starts in the midface: three-dimensional volumetric facial rejuvenation has beneficial effects on nontreated neighboring esthetic units.

Facial aging is a major indication for minimal invasive esthetic procedures. Dermal fillers are a cornerstone in the approach for facial sculpturing. But where to start? Our concept is midfacial volume restoration in first place. This will result in a healthy and youthful appearance creating a facial V-shape. But midfacial filler injection does not only improve the malar area. It has also beneficial effects on neighboring esthetic units. We report on such improvements in periocular and nasolabial region, upper lips and perioral tissue, and the jaw line and discuss anatomical background. We hypothesize that midfacial deep filler injections also may activate subdermal white adipose tissue stem cells contributing to longer lasting rejuvenation.

The Impact of Le Fort I Advancement and Widening on Nasiolabial Morphology

Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional (2D) data, and have not adequately distinguished between various Le Fort I subtypes. The purpose of this study was to 3-dimensionally (3D) analyze the changes to the nose and lip following Le Fort I comparing single-piece, expanded segmental, and surgically assisted expansion (SAME). We hypothesized that the type and magnitude of movement would influence the nasolabial morphology. A retrospective cohort study was performed including Le Fort I patients grouped as: 1) non-segmental straight advancement, 2) segmental with advancement and widening, 3) surgically assisted expansion, without advancement. 108 photogrammetric datasets were analyzed, including 46 single piece, 36 segmental, and 26 SAME. The male-to-female ratio was 0.5 (mean age, 23.5). 3D photos (Canfield, Fairfield NJ) from preoperative and greater than 6-months post-procedure were analyzed. Anthropometric landmarks were placed and measured by two independent observers. Statistical analysis involved both paired and unpaired t-tests (significance = P <0.05). Mean advancement was 5.8 (± 1.8) and 5.6 (± 2.3) for the single-piece and segmental groups respectively. Significant postoperative nasal changes were observed within each intragroup analysis. Cross-group analysis demonstrated the greatest increase in alar base width (Δ3.9± 1.6), alar width (Δ4.5± 1.4), nostril width (Δ1.6± 0.7), and soft triangle angle (Δ11.1± 4), all P < .05. Nasofrontal angle decreased within the single-piece group, while philtral width increased only among the segmentals. In conclusion, dramatic nasolabial changes occur following Le Fort I osteotomy. The 3D changes are discrete and differ depending on the osteotomy group subtype. This objective understanding permits more accurate surgical planning and patient counseling.

Maxillary Adenomatoid Odontogenic Tumor: A Case Report

Adenomatoid odontogenic tumor (AOT) is an asymptomatic lesion with slow but progressive growth that can be associated with impacted teeth. Its prevalence is highest in patients in the second decade of life. It is more common in the maxilla than in the mandible. Radiographically, AOT appears as a well-circumscribed, unilocular image, involving a non-erupted tooth. Histologically, AOT is composed of spindle-shaped, polygonal or cuboidal epithelial cells. A 15-year-old female presented with facial swelling in the nasolabial sulcus region, on the right side. Intraoral examination revealed a firm submucosal nodular growth, together with maxillary buccal and palatal cortical expansion, maintaining mucosal integrity. On the affected side, the right upper lateral incisor and right upper canine were absent. Panoramic radiography and computed tomography were performed. The patient underwent an excisional biopsy, and the surgical sample was submitted to histological examination. The histopathological diagnosis was AOT.

Réhabilitation implanto-portée des patients porteurs de fentes labio-alvéolo-palatines : étude rétrospective sur 43 patients

Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department. Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined. A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results. Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation.

Hatchet Flap: Clinical Evaluation of Results in Reconstruction of Lateral Nasal Region Defects.

Hatchet rotation-advancement flap is a well-known flap design, which is a worthwhile option in the reconstruction of lateral nasal region skin defects. In this study, the author's experience with 3 different designs of hatchet flaps, for the reconstruction of the defects in 3 different parts of the lateral nasal region, has been presented. All flaps in 31 clinical cases were planned from the cheek and nasolabial region. For the defects in the upper 1/3 part, flaps were planned in advancement type, for the middle 1/3 part, flaps were planned in rotation-advancement type, and for the lower 1/3 part, flaps were planned in rotation type. Satisfactory results were achieved in all patients except in patients having defects in the lower 1/3 part. In reconstruction of lateral nasal region defects, hatchet flap has different advantages such as versatility, better tissue match, and short final scar in the nasolabial fold. When planned in rotation type, for the lower 1/3 part, the ratio of complications increases significantly, which necessitates considering other flap options as the first-line choice of reconstruction for this region.

Effect of maxillary advancement on the change in the soft tissues after treatment of patients with class III malocclusion

The aesthetic outcome of treatment has become increasingly important to patients having orthognathic surgery. The aim of this observational cohort study based on clinical records was to evaluate the effect of maxillary advancement on changes to the soft tissues. We studied 53 patients with class III malocclusion (29 women and 24 men, mean (SD) age 28 (11) years). We identified all patients treated between 1 January 2002 and 30 December 2013 who could be monitored postoperatively for 6 months. To study the effect of maxillary advancement on changes to the soft tissue we distinguished between patients who had had less than 6mm, and those with 6mm advancement or more. In those who had had less than 6mm, we found no significant changes in the soft tissue in the region of the nasolabial angle. However, the lip-chin- throat angle (p=0.016), cervical length (p=0.002), lower lip (p=0.007) and upper lip distance (p=0.0001) from the aesthetic line changed significantly. On the other hand, the changes to the soft tissue in the submental and nasolabial regions were significant in patients with 6mm advancement or more, and indicated a clear improvement in the aesthetic outcome of this region. This aesthetic change for the good in the submental and nasolabial regions after maxillary advancement of 6mm or more should be considered when planning treatment, and reduction in the mandibular setback will reduce the risk of development of a double chin.

Nasal Profile Changes Following Anterior Maxillary Segmental Osteotomy: A Lateral Cephalometric Study.

Orthognathic surgery in reference to the maxilla attempts to correct underlying skeletal deformities and improve function. Consequently it has the potential to significantly alter the central esthetic unit of the face, the nasolabial region. In order to evaluate the nasal morphological changes which would result following anterior maxillary segmental osteotomy (superior and posterior repositioning); four angles namely, nasolabial, nasal tip projection, columellar labial and supra tip break angle were evaluated. In ten selected subjects who have undergone anterior maxillary segmental osteotomy with superior and posterior repositioning, pre (T1) and post operative (T2) lateral cephalometric parameters pertaining to the four angles were analysed using Wilcoxon signed rank test. A significant increase in nasolabial angle and mild changes in nasal tip projection, columellar labial angle and supra tip break angle were observed. The results of this study emphasize the need for the pre surgical evaluation of nasal morphology in every individual planned for anterior maxillary segmental osteotomy.