Normal Facial Appearance Research Articles

Computer-aided design and fabrication of nasal prostheses: a semi-automated algorithm using statistical shape modeling.

This research aimed to develop an innovative method for designing and fabricating nasal prostheses that reduces anaplastologist expertise dependency while maintaining quality and appearance, allowing patients to regain their normal facial appearance. The method involved statistical shape modeling using a morphable face model and 3D data acquired through optical scanning or CT. An automated design process generated patient-specific fits and appearances using regular prosthesis materials and 3D printing of molds. Manual input was required for specific case-related details. The developed method met all predefined requirements, replacing analog impression-making and offering compatibility with various data acquisition methods. Prostheses created through this method exhibited equivalent aesthetics to conventionally fabricated ones while reducing the skill dependency typically associated with prosthetic design and fabrication. This method provides a promising approach for both temporary and definitive nasal prostheses, with the potential for remote prosthesis fabrication in areas lacking anaplastology care. While new skills are required for data acquisition and algorithm control, these technologies are increasingly accessible. Further clinical studies will help validate its effectiveness, and ongoing technological advancements may lead to even more advanced and skill-independent prosthesis fabrication methods in the future.

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

The level of protein in the maternal murine diet modulates the facial appearance of the offspring via mTORC1 signaling

The development of craniofacial skeletal structures is fascinatingly complex and elucidation of the underlying mechanisms will not only provide novel scientific insights, but also help develop more effective clinical approaches to the treatment and/or prevention of the numerous congenital craniofacial malformations. To this end, we performed a genome-wide analysis of RNA transcription from non-coding regulatory elements by CAGE-sequencing of the facial mesenchyme of human embryos and cross-checked the active enhancers thus identified against genes, identified by GWAS for the normal range human facial appearance. Among the identified active cis-enhancers, several belonged to the components of the PI3/AKT/mTORC1/autophagy pathway. To assess the functional role of this pathway, we manipulated it both genetically and pharmacologically in mice and zebrafish. These experiments revealed that mTORC1 signaling modulates craniofacial shaping at the stage of skeletal mesenchymal condensations, with subsequent fine-tuning during clonal intercalation. This ability of mTORC1 pathway to modulate facial shaping, along with its evolutionary conservation and ability to sense external stimuli, in particular dietary amino acids, indicate that the mTORC1 pathway may play a role in facial phenotypic plasticity. Indeed, the level of protein in the diet of pregnant female mice influenced the activity of mTORC1 in fetal craniofacial structures and altered the size of skeletogenic clones, thus exerting an impact on the local geometry and craniofacial shaping. Overall, our findings indicate that the mTORC1 signaling pathway is involved in the effect of environmental conditions on the shaping of craniofacial structures.

The effect of strabismus surgery on psychosocial and functional quality of life

Aims: To evaluate the effect of strabismus surgery on psychosocial and functional quality of life. Methods: 50 adult strabismus patients who presented to our outpatient clinic with the complaint of strabismus in one eye were included in the study. Routine ophthalmologic examinations and strabismus controls were performed. With the diagnosis of monocular fixed eso/exotropia, unilateral horizontal muscle retraction and resection surgery were planned, and preoperative adult strabismus score (AS-20), Rosenberg self-esteem, body perception, and social appearance anxiety questionnaires were applied. A postoperative PD of 10 or less was considered success, and the questionnaires were repeated at the 2nd postoperative month. Results: The mean age of the patients was 21.54±3.95 (16-32) years. Twenty-two of the patients were female, and 28 were male. Pre-operative and post-operative strabismus AS-20 score, Rosenberg self-esteem, body perception, and social appearance anxiety scales showed statistically significant differences (p<0.05, p<0.001, p<0.001, p<0.001, p<0.001). Conclusion: Strabismus is an important disease that can cause difficulties in social life both in childhood and adulthood. The aim of strabismus surgery is to restore normal facial appearance as well as functional correction. Our study results showed that successful strabismus surgery can improve the psychosocial and functional quality of life.

Therapeutic management of osteodystrophia fibrosa in early weaned Malabari male goat kids.

Osteodystrophia fibrosa is a metabolic disease of goats resulting from the insufficient mineralization of bones, excessive bone resorption, and improper bone development, leading to subsequent accumulation of the fibrous connective tissue. This report describes the successful therapeutic management of acute osteodystrophia fibrosa in early-weaned goat kids by following a medical protocol. Three Malabari male goat kids of forty days old from two different litters of the same farm were presented with spontaneous, bilaterally symmetrical, non-inflammatory facial swelling, protruded tongue, prominent eyeballs, frothy drooling saliva, diarrhoea, and inanition due to the inability in mastication or suckling for the last two weeks. As per the history, these kids were weaned and started feeding pelleted concentrate feed and jackfruit leaves along with the milk sucking three weeks back only. On clinical examination, the vital parameters were normal and the key phenotypic abnormalities noted were the abnormally developed maxilla/mandible, manifested as a swelling that was hard to touch, and the loosely attached teeth. In biochemical evaluation, the reduction in Ca:P ratio was evident and the serum creatinine level was within normal ranges. A therapeutic protocol was devised for three weeks by including calcium (calcium gluconate), phosphate-binder (Kaolin), vitamins (Vit. ADEH), and anabolic steroid (Nandrolone; a well-established drug promoting formation and mineralization of bone in mammals). Considerable improvement was observed after three weeks of therapy and the animals were having apparently normal facial appearance on the review after three months. The kids showed normal healthy growth and were slaughtered later for meat purpose after gaining adult body weight. This report accentuates the possibility of acute hypocalcemia-induced osteodystrophia fibrosa, rather than hyperphosphatemia-induced, and its management using anabolic steroids for better clinical recovery in growing goat kids.

Osteogenic differentiation of 3D-printed porous tantalum with nano-topographic modification for repairing craniofacial bone defects.

Introduction: Congenital or acquired bone defects in the oral and cranio-maxillofacial (OCMF) regions can seriously affect the normal function and facial appearance of patients, and cause great harm to their physical and mental health. To achieve good bone defect repair results, the prosthesis requires good osteogenic ability, appropriate porosity, and precise three-dimensional shape. Tantalum (Ta) has better mechanical properties, osteogenic ability, and microstructure compared to Ti6Al4V, and has become a potential alternative material for bone repair. The bones in the OCMF region have unique shapes, and 3D printing technology is the preferred method for manufacturing personalized prosthesis with complex shapes and structures. The surface characteristics of materials, such as surface morphology, can affect the biological behavior of cells. Among them, nano-topographic surface modification can endow materials with unique surface properties such as wettability and large surface area, enhancing the adhesion of osteoblasts and thereby enhancing their osteogenic ability. Methods: This study used 3D-printed porous tantalum scaffolds, and constructed nano-topographic surface through hydrothermal treatment. Its osteogenic ability was verified through a series of in vitro and in vivo experiments. Results: The porous tantalum modified by nano-topographic surface can promote the proliferation and osteogenic differentiation of BMSCs, and accelerate the formation of new bone in the Angle of the mandible bone defect of rabbits. Discussion: It can be seen that 3D-printed nano-topographic surface modified porous tantalum has broad application prospects in the repair of OCMF bone defects.

Cross Sectional Analysis of Eurasian Skull Anatomy for 3D Cephalometry-Normative Data Reveal Four Different Skull Types.

The unsolved problem in three-dimensional surgical planning for patients with facial deformity, dysgnathia, or asymmetry is the lack of a normative database of "norm skulls" that can be used as treatment objectives. A study was conducted on 90 Eurasian persons (46 male and 44 female adults) for whom cone beam-computed tomography images were available. Inclusion criteria were adult patients with a skeletal Class I pattern, proper interincisal relationship with normal occlusion, the absence of an open bite both in the anterior and posterior region, and a normal and balanced facial appearance; patients with dysgnathia and malformations were excluded. A total of 18 landmarks were digitized and 3D cephalometric measurements were performed and analyzed by means of proportions calculated from the landmarks. Male and female skulls were analyzed, as well as subdivisions revealed by cluster analysis. The data showed that four subtypes of skulls were distinguishable with statistical significance (p < 0.05). A male and a female type subdivided in a brachiocephalic and dolichocephalic phenotype could be identified. For each type, a mean shape was calculated by a Procrustes transformation, which, in turn, was used to create four template skulls from a male and a female skull. This was accomplished by fitting the polygon models of the two skulls to each of the two subtypes based on the landmarks marked on them using a thin plate spline transformation. The normative data of the subtypes can individually serve as a guide for orthodontic surgery in the Eurasian population, which is especially helpful in 3D planning and the execution of craniofacial operations.

Ocular Prosthesis: A Next Generation Cosmetic Management by an Eye for an Eye

An ocular prosthesis is an artificial eye that replaces an absent natural eye following an enucleation, evisceration or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids that covers the structures in the eye socket. It is a non-optical device designed only to improve the cosmesis of an individual with anophthalmic socket or disfigured eye. A normal facial appearance is one of the inherent human traits, if any changed or lost challenges physical, social, mental well-being, self-confidence and psychological influence on the affected people. The loss of an eye is a severe psychological trauma with negative impact on the quality of life of the patient. It is quite challenging to restore the normal look of the patient for bringing him to normality in society. In this view, an ocular prosthetic eye helps to improve the quality of life, satisfaction and appearance of affected eye to any injury or disease of the patient. It is given to uplift the patient’s behavioral, mental status and improve the confidence especially in children. Today, most artificial eyes are made of medical grade plastic acrylate (polymethyl methacrylate material) with an average life of about 2-3years depending upon the way that people use it. It is commonly known as “Device or Scleral Shell or Glass Eye or Fake Eye”. The children require more frequent replacement of the prosthetic eye due to rapid growth changes in the eye. The construction of an ocular prosthesis in the case of congenital and acquired anophthalmia differs in etiology but many concepts of management for a child are the same as for an adult. An early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry.

Orbital and eyelid diseases: The next breakthrough in artificial intelligence?

Orbital and eyelid disorders affect normal visual functions and facial appearance, and precise oculoplastic and reconstructive surgeries are crucial. Artificial intelligence (AI) network models exhibit a remarkable ability to analyze large sets of medical images to locate lesions. Currently, AI-based technology can automatically diagnose and grade orbital and eyelid diseases, such as thyroid-associated ophthalmopathy (TAO), as well as measure eyelid morphological parameters based on external ocular photographs to assist surgical strategies. The various types of imaging data for orbital and eyelid diseases provide a large amount of training data for network models, which might be the next breakthrough in AI-related research. This paper retrospectively summarizes different imaging data aspects addressed in AI-related research on orbital and eyelid diseases, and discusses the advantages and limitations of this research field.

TREATMENT OF A PATIENT DIAGNOSED WITH ERDHEIM CHESTER'S DISEASE IN COOPERATION WITH PLASTIC SURGERY AND HEMATOLOGY

Erdheim Chester disease (ECD) is a rare non-Langerhans histiocytic multisystem disorder. ECD is most commonly manifested as multifocal sclerotic long bone lesions. Orbital and intraocular manifestations are rare. We report an unusual bilateral orbital presentation as xanthomatous infiltration of ECD. A 56-year-old male was admitted due to papular lesions on both eyelids. Eyelid tissue histology showed histiocytic infiltration consistent with ECD. BRAF V600E mutation (-). In the first year, PET-CT showed new lesions on the lymph node, eyelids, knees and elbows. Laboratory investigation was within normal apart of mild increased CRP. The disorder was unresponsive to pegylated interferon alfa. With cladribine of 3 courses and surgical intervention he achieved a nearly normal facial appearance. Uncontrolled cell survival, differentiation, and proliferation of histiocytes in ECD result in soft tissue thickening and progressed to chronic fibrotic disease which may be unresponsive to medical treatments and requires surgical interventions.

EP238: Inner epicanthal and nasal pits as presenting feature of holoprosencephaly

Holoprosencephaly (HPE) is a structural anomaly of the brain resulting from incomplete forebrain division during gestation. HPE is a continuum of brain malformations with the most severe form, alobar, referring to a midline monoventricle to a mild form with relatively normal facial appearance and subtle brain defects. There are a number of chromosome abnormalities associated with HPE as well as monogenic causes.

Orthodontic Treatments of Papillon-Lefevre Syndrome: Two Case Reports

Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder characterized by palmoplantar hyperkeratosis and early onset of severe destructive periodontitis causing premature loss of both deciduous and permanent dentitions at a young age. In this article two cases of patients with Papillon-Lefevre syndrome in late mixed dentition are presented. The objective of these case reports was to illustrate that under a controlled regime of periodontal treatment, orthodontic treatment is possible in patients with Papillon-Lefevre syndrome. In both cases, the deciduous dentition was lost prematurely shortly after eruption. The permanent teeth erupt without any guidance, and this can lead to loss of space, crowding, and collapse of the dental arch. The aim of the treatment was to expand the arch, create space to allow normal eruption of the permanent teeth, and stabilize the occlusion to help the patient achieve a normal facial appearance rather than the collapsed appearance caused by early extractions. KEYWORDS: Papillon-Lefevre Syndrome, Orthodontics, Mixed dentition, Case reports

Recurrent c.776T>C mutation in CHST3 with four other novel mutations and a literature review.

The chondrodysplasia with congenital joint dislocations, CHST3 type, which was distinguished by predominantly contractures, marked vertebral changes, and normal facial appearance. Although, some clinical clues can be used for differential diagnosis, it is mostly too difficult to discriminate one type from another on basis of clinical findings only. Eight patients with multiple dislocations from five unrelated families were included in this study to elucidate molecular diagnoses. Clinical exome sequencing (CES) was performed on one patient from each family. Variable degree vertebral changes, pes equinovarus, and kyphoscoliosis accompanied multiple dislocations and short stature. In CES analyses, all mutations showed in CHST3. Previously reported c.776T>C homozygous mutations were detected in two families, compound heterozygous novel c.740G>C and c.881T>C mutations were found in one family, and homozygous novel c.564C>A and c.963G>A mutations were also determined in remaining two families, separately. Biallelic CHST3 c.776T>C mutations are most frequent mutation in CHST3 and have been reported predominantly in Turkish patients which may be remarkable for genotype-ethnicity correlation in chondrodysplasia with congenital joint dislocations, CHST3 type. It is suggested that c.776T>C mutation can be accepted as a recurrent mutation in CHST3 for Turkish patients who are suspected of having chondrodysplasia with congenital joint dislocations, CHST3 type.

Reconstruction Of Noe Fracture With Immediate Diced Costal Cartilage Grafting: A Case Series

&#x0D; &#x0D; &#x0D; &#x0D; Background : Naso-orbital-ethmoid (NOE) fracture is one of the common injury and the management remains difficult and controversial due to the anatomic complexity. Severe facial deformity and dysfunction are the results from the untreated injury. Moreover, the results from many procedures are not aesthetically satisfying. Meanwhile diced cartilage graft popularity is increasing in order to correct nasal deformity whether post trauma, revision (secondary) rhinoplasty or cleft nose. The procedure is less time consuming, easy to perform and also highly malleable.&#x0D; Methods : This study presents our experience in managing four patients with NOE fracture using costal cartilage graft technique immediately after injury. A columellar V-shaped incision was made, the finely diced cartilage harvested from the eight rib was injected to the glabella, dorsum and nasal tip using one cc syringe needle with cut tip. Demographic data were obtained from the patients’ medical record. Post-operative results were observed.&#x0D; Result: The four surgeries were done, with average 5.75 (range, 2-9) days after injury. During the observation, nasal tip misalignment was observed in only one patient. Diced cartilage were not visible through the skin, although it could be palpable. No cartilage extrusion were occurred. After averange follow up 10.25 mo (range 8-12 mo) All patients were satisfied with their facial appearance.&#x0D; Conclusion: The fracture of NOE can be manage with immediate diced costal cartilage graft, since this treatment can achieve a normal facial function and appearance. The complications are low and manageable, making it as serious contender technique of choice in managing NOE fracture to other techniques.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Keywords: NOE fracture, diced costal cartilage graft, facial fracture&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Volumetric and three-dimensional examination of sella turcica by cone-beam computed tomography: reference data for guidance to pathologic pituitary morphology.

The aim of the study was to assess the dimensions and volume of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance from cone-beam computed tomography (CBCT) images. CBCT images of 80 Caucasian adult patients (40 males, 40 females) with normal facial appearance and occlusion taken previously for diagnostic purposes were evaluated. Two groups were constructed in accordance to gender. The volume, length, diameter, and depth of the sella turcica were measured by Romexis software programme. Mann-Whitney U test and Independent t-tests were used for statistical analysis. The mean lengths of the sella were 9.9 mm and 10.2 mm, depths were 9.2 mm and 8.8 mm and diameters were 12.3 mm and 12.1 mm in female and male groups, respectively. Between the genders, no statistically significant differences were found for any of the measurements. There were significantly higher values for the volume of sella turcica in males than in females (1102 ± 285.3 mm3 and 951.3 ± 278.5 mm3, respectively). The dimensions of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance revealed nonsignificant differences between the genders. Individual variability in dimensions and gender differences in the volume are of importance in comparison of patients with craniofacial syndromes and aberrations. Knowledge concerning the dimensions and volume of sella turcica will be clinically relevant for a guidance to consciously realize pituitary disorders.

Three-dimensional cephalometry for orthognathic planning: Normative data and analyses

The objective of this study was to create a normative database of 3D cephalometric measurements for adult Chinese in Taiwan to understand the specific features, as well as to provide information for 3-dimensional (3D) orthognathic surgery planning for patients with maxillofacial deformity. A cross-sectional study was conducted on 30 male and 30 female adults with normal and balanced facial appearance, skeletal Class I pattern, and proper interincisal relationship with normal occlusion. Cone-beam computed tomography was performed. After standard orientation of the 3D image models, 51 landmarks were digitized and 3D cephalometric measurements of overall facial features, midface, maxilla, mandible, dentoalveolus, and soft tissue were performed and analyzed. Reliability and reproducibility of the 3D measurement were achieved. The data showed significant differences between males and females in facial height ratio, midface prominence, midface and maxilla width, mandible width and length for the skeleton, lower incisal inclination and interincisal angle for the dentoalveolus, and lip height, facial height and chin throat angle for the soft tissue. These dataset presented specific facial characteristics of the Chinese face as compared with other populations. The normative data helps to serve as a guide for maxillofacial treatment for globally ethnic Chinese, particularly useful for orthodontic treatment, 3D planning of orthognathic surgery and outcome assessment. Gender and ethnic differences need to be taken into consideration.

Resolution of self-injurious behavior in a nonverbal and developmentally delayed patient after surgical treatment of a blind painful eye

Changes in behavioral patterns can be the only indication of the presence of pain in nonverbal patients. Phthisis bulbi results in shrinking, disorganization, and sometimes severe inflammation of the ocular globe and can occur after eye injury or multiple eye surgeries. Chronic tearing, frequent eye rubbing, and self-injurious behavior focused around the eye and periocular region may indicate ocular discomfort in nonverbal patients. In eyes that become painful and refractory to medical treatment, ocular evisceration or enucleation can provide immediate pain relief. An ocular prosthesis provides excellent cosmetic results to restore normal facial appearance after surgery.

Identification of the Single Nucleotide Polymorphisms Affecting Normal Phenotypic Variability in Human Craniofacial Morphology Using Candidate Gene Approach

There is a remarkable variety of human facial appearances, almost exclusively the result of genetic differences, as exemplified by the striking resemblance of identical twins. Despite intensive research on the genetics of craniofacial morphology using animal models and human craniofacial syndromes, the genetic variation that underpins normal human facial appearance is still largely elusive.

Treatment of mycobacterium tuberculousis induced with cosmetic injection

Objective To explore the diagnosis and treatment of non-tuberculosis mycobacteria (NTM) infection after cosmetic injection via scientific debridement surgery combined with regular application of anti-NTM drugs. Methods 14 patients who were infected with NTM after cosmetic injection and were not cured over a long period of time in other hospitals from 2012 to 2016. The patients were treated with VSD thorough surgical debridement, the bacterial type of NTM was identified by bacterial culture and PCR identification and anti-NTM drugs were systematically used according to the results of drug sensitivity. Results Fourteen patients who were treated with scientific debridement surgeries combined with regular anti-NTM drug treatment in our hospital for 2-4 months were discharged after their skin lesions were cleared and healed and they were continually treated with anti-NTM drugs for 12 months. Fourteen patients were completely cured by using the above treatments without severe side effects, such as liver and kidney dysfunction, nervous system disorders and so on. Only colpitis mycotica occurred in 3 patients. In addition, one patient presented the decrease of leukopenia after using anti-NTM drugs for 2 months and continued to complete the treatment after we adjusted the treatment plan to returning the level of leukopenia to the normal. These 14 patients were followed up for 1-5 years with no recurrence of the lesion. The facial appearance of 12 patients were almost normal with slight scars. The facial surgery area of 2 patients were uneven and nearly recovered to normal facial appearance by tissue transplantation and photoelectric therapy. Conclusions For the NTM patients caused by invasive procedures such as injection, the comprehensive treatment program, which combined scientific debridement surgery and systematically targeted drug treatment, not only can effectively cure NTM infection, but also minimize secondary injury and restore the patients' appearance, which is worthy of clinical application. Key words: Improving looks; Injections; Mycobacterium infections, nontuberculous; Debridement; Drug therapy

The Esthetic and Psychologic Benefits of an Intraoperative Provisional Restoration.

When multiple visible teeth are prepared, the prolonged treatment time may lead to patients needing a break that requires them to leave the operatory. Such a situation allows the patient to view their prepared teeth, a process that can be disconcerting to some patients. An intraoperative provisional restoration can be made by using a thermoplastic vacuum-formed matrix of the patient's teeth that is filled with white-colored impression material and then placed over the prepared teeth to form a provisional restoration. The use of an intraoperative provisional restoration can be effectively used to cover prepared teeth while providing normal tooth morphology and facial appearance after preparation of visible teeth. When visible teeth are prepared, an intraoperative provisional restoration can be used to cover the prepared teeth and prevent concerned patients from viewing their prepared teeth. (J Esthet Restor Dent 29:189-192, 2017).