Postoperative Soft Tissue Changes Research Articles

Reliability of CIR-S using the subperiosteal pocket technique under 2 years of age

Objective It is aimed in this study to investigate the reliability of the cochlear implant receiver-stimulator (CIR-S) placement using unfixed subperiosteal tight pocket technique and the postoperative soft tissue changes that occur around the CIR-S, in toddlers under 2 years of age. Methods Nonsyndromic toddlers with normal radiological findings and who were planned to have cochlear implantation were included in the study. Preoperative and postoperative complications, device migration, and postoperative soft tissue changes occurred around the CIR were analyzed using objective methods. Results Twenty-six toddlers aged between 12 and 24 months who met the study criteria were followed up for a mean follow-up duration of 18 months. No intraoperative and postoperative surgical complications and device migration were observed in any of the cases included in the study. Conclusion It was concluded as a result of this study that cochlear implant receiver-stimulator placement using the subperiosteal pocket technique is reliable in toddlers under 2 years of age, provided that the small incision tight subperiostal pocket technique is performed meticulously without fixation and well drilling, and that device-protective changes occur in the tissues around the CIR-S over time with the use of the device and as the child skull develops.

Appearance of recurrent dermatofibrosarcoma protuberans in postoperative MRI follow-up

Purpose: To analyze the appearance of recurrent dermatofibrosarcoma protuberans (DFSP) in postoperative MRI follow-up and to assess the occurrence of postoperative soft tissue changes detected in MRI.Methods: A total of 464 MRI follow-up scans of 32 patients with histologically proven diagnosis of DFSP were analyzed. MR imaging was performed using a 1.5T MRI system. Recurrent DFSP was examined for signal intensity, contrast behavior, appearance, and extent in MRI.Results: The mean age of the patients was 44,5±17,1 years. Recurrences of DFSP occurred 26±23.3 months after primary tumor resection in the mean (Min.: 9, Max.: 60). In 25% of the patients (n = 8), recurrences of DFSP were detected. Recurrent DFSP most often showed a nodular and homogeneous configuration with well-defined borders and marked contrast enhancement, and a hyperintense signal in PD-weighted and turbo inversion recovery magnitude sequences. All recurrences were well detected in the follow-up MRIs regardless of the performed plastic surgery procedure. Lateral and depth margins had no significant impact on the local recurrence rate. In all, 88% of the patients developed subcutaneous tissue edema (p < 0.01), followed by muscle edema (34%, p = 0.02), and postoperative seroma (22%).Conclusion: Recurrent DFSP mainly appear uniform and clearly delimitable on MRI as nodular, homogeneous, and well-defined lesions with marked contrast enhancement. Therefore, MRI is a valuable tool for postsurgical follow-up. Nearly all patients develop subcutaneous edema after the resection of DFSP.

Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism.

Both deep understanding and reliable prediction of postoperative soft tissue changes are crucial for planning orthognathic surgery. Instead of estimating soft tissue responses by measuring individual landmark changes, this study aimed to investigate the relationship (ratio) between soft and hard tissue movements in different facial regions through three-dimensional cone-beam computed tomography (CBCT). Preoperative and postoperative CBCT images were superimposed using the surface registration method on the basis of the cranial base, and 10 facial regions of interest were defined. Region-based volumetric subtractions between the preoperative and postoperative segments were performed. The volumetric differences and surface of each region were used to estimate the average movement. Correlation and regression analyses were performed to examine the relationships between the corresponding soft and hard tissue movements. An overall pattern of facial soft tissue movement was observed in patients with prognathism who underwent orthognathic surgery. The experiment results have shown that mean ratios for the average soft-to-hard tissue movements in the facial regions varied, which may not exactly be similar to the published reports because of the population biocharacteristics and study methods, but the trend is in agreement with the previous studies. Additionally, the prediction capability of the regression model was significantly high, ranging from 0.786 to 0.857, in upper lip, upper vermilion, and chin regions, thus demonstrating that the skin outline changes in these critical regions could be reliably predicted from the underlying bone movements. These results could likely be applied in future soft tissue simulation in orthognathic surgery.

The accuracy of three-dimensional prediction of soft tissue changes following the surgical correction of facial asymmetry: An innovative concept

The accuracy of three-dimensional (3D) predictions of soft tissue changes in the surgical correction of facial asymmetry was evaluated in this study. Preoperative (T1) and 6–12-month postoperative (T2) cone beam computed tomography scans of 13 patients were studied. All patients underwent surgical correction of facial asymmetry as part of a multidisciplinary treatment protocol. The magnitude of the surgical movement was measured; virtual surgery was performed on the preoperative scans using Maxilim software. The predicted soft tissue changes were compared to the actual postoperative appearance (T2). Mean (signed) distances and mean (absolute) distances between the predicted and actual 3D surface meshes for each region were calculated. The one-sample t-test was applied to test the alternative hypothesis that the mean absolute distances had a value of <2.0mm. A novel directional analysis was applied to analyse the accuracy of the prediction of soft tissue changes. The results showed that the distances between the predicted and actual postoperative soft tissue changes were less than 2.0mm in all regions. The predicted facial morphology was narrower than the actual surgical changes in the cheek regions. 3D soft tissue prediction using Maxilim software in patients undergoing the correction of facial asymmetry is clinically acceptable.

Soft tissue changes after a combined lefort I and anterior maxillary osteotomy: A clinical and cephalometric study

Background: Orthognathic Surgery is indicated in severe skeletal disharmony on the best means of improving functional facial esthetic. Assessment of the facial harmony in relation to soft tissue contour the thickness of the tissues, the lip length to postural tone plays an important role. This article aims determining the changes of the soft tissue profile cephalometrically after maxillary osteotomy. Material and Methods: The entire concept of orthognathic surgery involves the identification of the hard and soft tissue deformity by clinical examination, cephalometric radiographs, models and photographs. This study is to assist the pre and post-operative soft tissue changes clinically including width of the nasal bone and upper incisor exposure of rest and cephalometrically including nasolabial angle, facial convexity, lip protuberance and inter-labial gap by using Rickets E Line, Steiner's S Line, Merrifield's Z Angle and Holdaway Soft Tissue Analysis. Results: There is significant dramatic improvement in the soft tissue profile cephalometrically after maxillary osteotomy. Conclusion: The conclusion of the study is that there is a change in the soft tissue in relation to the hard tissue movement, and also the stability of the soft tissue profile was established by rigid fixation of bony segments.

Post-operative soft tissue changes in patients with mandibular prognathism after bimaxillary surgery

The objective of this study was to evaluate the three-dimensional soft tissue changes observed over time after bimaxillary surgery for mandibular prognathism using cone-beam computed tomography (CBCT) superimposed imaging. CBCT scans were obtained for 25 patients before bimaxillary surgery (T0), at 2 months after surgery (T1) and at 6 months after surgery (T2). Cephalometric variables from the reoriented volumetric images were measured and compared at T0, T1, and T2. The quantitative surface displacement in the middle and the lower third of the facial soft tissue using CMF tools was assessed by superimposing the T0 and T1 or T0 and T2 3D images. The soft tissue in middle third of face moved forward at T1 and significantly moved backward from T1 to T2 (Ch-Al, p < 0.001; Al, p < 0.05; Pn, p < 0.05). Most of the soft tissue changes from T1 to T2 were not correlated with the hard tissue changes (p > 0.05), while the cheeks were positively correlated with the soft tissue around them (Exo-Al, p < 0.01; Ch-Al, p < 0.01). Post-operative soft tissue changes occurred in the middle third of the face and are considered to be more complex than the changes in the lower third of face. Therefore, soft tissue assessment at least 6 months after surgery is desirable.

Soft tissue stability in segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up

This study evaluated soft tissue changes in adult patients treated with distraction osteogenesis (DOG) of the anterior mandibular alveolar process and related it to different parameters. 33 patients (27 females; 6 males) were analysed retrospectively before surgery at T1 (17.0 days), after surgery at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Statistical analysis was carried out using Kolmogorov–Smirnov test, paired t test, Pearson's correlation coefficient, and linear backward regression analysis. 2 years postoperatively (T4), the net effect of the soft tissue at point B′ was 100% of the advancement at point B whilst the lower lip (labrale inferior) followed the advancement of incision inferior to 46%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T4–T3) for labrale superior and pogonion′. Higher NL/ML′ angles were significantly correlated (p<0.05) with smaller horizontal soft tissue change at point B′. Gender and the amount of skeletal and dental advancement were not correlated with postoperative soft tissue changes (T4–T3). DOG of the anterior mandibular alveolar process is a valuable alternative for mandibular advancement regarding soft tissue change and predictability.

Soft tissue changes after advancement genioplasty performed as pedicled or free transplants

The influence of soft tissue attachment in augmentation genioplasty on postoperative soft tissue changes was studied in 25 patients. The soft tissue was completely detached from the advanced genial segment in 14 patients and lingual soft tissue was maintained in 11 patients. The patients were followed for a minimum of 1 year after operation and the soft tissue and bone changes were analysed by measuring linear distances and areas on lateral cephalograms. The result indicated that the soft tissue changes after surgery were significantly different between the two types of graft. In the free grafts there was found to be an increased risk of creating a larger interlabial gap and exposure of the labial surface of mandibular incisors. The higher correlations between hard and soft tissue changes in the pedicled grafts indicated that the predictability is better with this operative technique.