Facial Reconstruction Research Articles

Delayed Onset Perinasal Mucocele Cyst in a Patient With Remote History of Orofacial Cleft Repair.

Nasoalveolar cysts are rare, nonodontogenic cysts with a subtle course that can lead to nasal deformity and, uncommonly, nasal airway obstruction. Herein the authors present the case of a 28-year-old male who presented with a recurrent left-sided nasoalveolar cyst. Upon presentation, this cyst had formed a significant alar defect and was obstructing the left nasal airway. Although nasoalveolar cysts have been well-described in literature, the patient represents an atypical case in that nasoalveolar cysts most commonly occur in females and in patients aged 40 to 60 years old. The patient's history of extensive facial reconstruction for cleft palate and lip is also anomalous and suggests an inclusion cyst rather than a cyst of typical epithelial origin. The complex course of this cyst and the history of this patient, which led to treatment with a subdermal dissection, septoplasty and turbinate reduction, and alar defect correction make this case of particular note.

Utilization of Computer-Assisted Navigation Technology Within Craniomaxillofacial Fracture Surgery: A Systematic Review.

Use of intraoperative computer-assisted navigation (iCAN) has been well-established in otolaryngology and neurosurgery; however, its use in surgical management of facial fractures is yet to be reported on a large scale. This study aimed to review the existing literature to determine the outcomes, limitations, risks, and benefits of iCAN use in facial fracture management. A systematic review of iCAN use in craniomaxillofacial fracture surgery was performed by 2 authors in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted on 3 databases, PubMed, Cochrane Library, and Embase, using the search terms "navigation," "intraoperative," and "brain lab" in combination with "facial fractures" or "facial reconstruction." Study type, demographics, fracture characteristics, surgery characteristics, iCAN devices, intraoperative fracture fixation accuracy, postoperative outcomes, complications, navigation limitations, and risks and benefits were analyzed. There were 909 studies identified in the initial search, of which 42 were chosen for final use. iCAN use was most commonly reported in unilateral (57.1%) and complex (50%) facial fracture cases. Surgical accuracy ranged from 0.7 to 4 mm and postoperative discrepancy ranged from 0.05 to 8 mm. Benefits included improved intraoperative surgical accuracy (95.2%), improved postoperative surgical discrepancy (52.4%), and decreased total surgical time (35.7%). Limitations reported with iCAN device use included operative technical difficulties (23.8%) and persistent systematic errors during device registration (21.4%). None of the studies discussed cost analysis or risks compared to conventional fixation methods. Advancements in and increasing familiarity with iCAN technology have preliminarily shown favorable surgical outcomes in facial fracture fixation, which include improved operative accuracy and discrepancy and decreased surgical time.

Facial Reconstruction: The Nuances of Managing Undesirable Results

AbstractGiven the visibility of the face and the importance of its cosmesis, undesirable results following facial reconstruction present significant challenges for both the patient and the surgeon. Intraoperative measures and postoperative management can ameliorate some unfavorable outcomes, but others may require more extensive intervention. Approaching undesirable results with a frank assessment followed by shared decision-making not only improves outcomes but is also essential for patient satisfaction.

How to improve ZMC fracture reconstruction due to severe enophthalmos

Introduction and importanceZygomaticomaxillary (ZMC) fractures are common, often resulting from traffic accidents, and account for 17 % of facial fractures. These fractures can lead to issues such as enophthalmos, flattened cheeks, diplopia, maxillary hypoesthesia. If the reduction is inadequate to restore facial structure, long term-functional and aesthetic complications may arise. In such cases a computed tomography (CT) scan with 3-dimensional (3D) reconstruction is valuable to assessing the fracture and planning surgery, with current technological advancements, 3D printing can now be utilised for this purpose. Presentation of caseA 24-year-old male, after a motorcycle accident and initial surgery for maxillofacial fractures, experienced persistent diplopia and facial numbness. Physical examination showed malpositioning of the right eye, and a CT scan with 3D reconstruction revealed multiple fractures and prior internal fixation. A 3D-printed model was created to plan a second surgery using rib cartilage and a silicone orbital base for orbital rim reconstruction. Post-surgery, the patient reported minimal pain and no diplopia or blurred vision in the primary gaze position. Clinical discussions3D printing is beneficial in facial reconstruction, aiding in surgical planning by allowing precise measurement and design of graft. Rib cartilage can serve as an alternative for orbital rim reconstruction, and 3D printing facilitates accurate harvesting of the rib. ConclusionIn cases of severe ZMC fracture, 3D printing was utilised as a guide during surgical preparation to achieve improved outcomes.

Tulum’s underwater caves: insights into the oldest human fossils in the Americas

Evidence of late Pleistocene human and fauna remains has been documented within the extensive cave systems of the Tulum region in northeast Yucatán, Mexico. This unique area is vital for paleontological and paleoanthropological research, providing insights into early human adaptation in the Americas. To date, 10 human fossils have been thoroughly studied, with two additional recent discoveries under investigation. These remains, dating from 13,700 to 8,000 BP, emphasize the paleoanthropological significance of Tulum's submerged caves. A key discovery is the skeleton of Eva de Naharon, dated to 13,721 years cal BP, making her the oldest known human fossil in the Americas. Using 3D facial reconstructions and DNA analysis, researchers have identified craniofacial similarities with South Asian populations, suggesting shared ancestry and migration patterns. These findings enrich our understanding of human migration and adaptation. Ongoing research continues to highlight the role of Tulum’s underwater caves in shaping early human history, survival strategies, and social structures over millennia.

Facial and dental arch shape in individuals with different bite force levels : A pilot study using geometric morphometrics.

This pilot study aimed to assess the relationship between bite force variation and dental arch and facial shape using geometric morphometrics, an advanced method of statistical analysis that provides adetailed shape analysis of astructure considering the spatial relationship of its parts. The sample consisted of 16German adult men and women. For each individual, maximum bite force was recorded in four positions: maximum intercuspation, protrusion, laterotrusion to the right and to the left. Facial and three-dimensional (3D) dental reconstructions were obtained from 3D facial photographs and 3D scans of dental stone models. Atotal of 51landmarks were placed. General shape variation was assessed by principal component analysis. Partial least squares analyses were performed to evaluate the covariation between bite force, facial shape, and dental shape. There was no clear pattern or statistically significant covariation between our variables. Our results suggest aweak relationship between bite force, dental arch, and facial shape. Considering previous work in this field, we propose that low masticatory loads, characteristic in Western urban populations, may explain this. Further studies should, therefore, address this issue, taking into account effect size, the mechanical properties of the diet, and other relevant variables.

Retraction Note: Three-dimensional face reconstruction of static images and computer standardization issues

Retraction Note: Three-dimensional face reconstruction of static images and computer standardization issues

The Use of 3D Model Printing for Acute Planning in Oral and Maxillofacial Traumatology

Introduction Due to the complex anatomy of craniomaxillofacial structures, facial reconstruction following high-impact traumas is extremely challenging. Therefore, this study aimed to evaluate the use of biomodels in the surgical planning of complex fractures and the sequelae in the oromaxillofacial region. Materials and Methods This is a cross-sectional, exploratory, descriptive, and quantitative documentary study. It was conducted at the “Dom Luiz Gonzaga Fernandes” Emergency and Trauma Hospital, in the hinterland of the state of Paraíba, in Brazil, based on cases recorded between November 2021 and November 2022. The research instrument utilized was a self-developed questionnaire. Results No statistically significant correlation was observed between the biomodel acquisition time and the length of hospitalization, with a Spearman's correlation coefficient of r = -0.079. Although the need for adjustment of osteosynthesis material was 50% in cases where acrylonitrile butadiene styrene (ABS) models were used, with p (1) = 0.464, in order to be significantly more faithful, it would require a study with a higher sample size. The average length of surgery, in minutes, was 91.25 ± 28.00. The average cost of the materials used to manufacture the biomodels, in Brazilian reais (R$), was R$122.00 ± R$89.09. Conclusion The use of biomodels in the surgical planning of complex fractures and oromaxillofacial sequelae did not increase the length of hospitalization. The material used for the prototype manufacture suggests a potential influence on its faithfulness. The length of surgery was shorter in interventions that utilized biomodels in the planning phase. It was also noted that the average cost of manufacture varies according to the type of material chosen and the quantity required.

Surgery for facial palsy in the hands of otorhinolaryngologists: a population-based study.

Modern facial surgery can improve eye closure and address facial functional and emotional expression disabilities in case of severe acute facial paralysis with low probability of recovery and in cases of chronic flaccid facial paralysis. Reports on outcome typically originate from specialized tertiary care centers, whereas population-based data from routine care beyond specialized centers is sparse. Therefore, patients' characteristics, surgical techniques, postoperative complications, and patients' satisfaction with the final outcome were analyzed for all inpatients with facial paralysis undergoing facial surgery in Thuringia, a federal state in Germany, between 2006 and 2022. 260 patients (female 41.5%; median age 65 years) were included. On average, the surgery rate was higher for men than for women (0.83 ± 0.39 versus 0.58 ± 0.24 per 100,000 population per year). For first surgery, static procedures were dominating (67.3%), followed by dynamic reconstruction (13.8%), and combined static and dynamic reconstructions (13.5%). The most frequent type of surgery was upper lid weight loading (38.5%), hypoglossal-facial jump nerve suture (17.3%), and facial-facial interpositional graft suture (16.9%). Bleeding/hematoma formation needing revision surgery was the most frequent complication (6.2%). Overall, 70.4% of the patients were satisfied with the final result. The satisfaction was higher if the target was to improve eye closure (65.2%) or to improve upper face function (65.3%) than to improve the lower face function (53.3%). If facial nerve reconstruction surgery and/or upper lid weight placement was performed, the satisfaction was significantly higher. If revision surgery was needed to improve the result, the satisfaction was significantly lower.

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Poliface: A Multi-pose Synchronous Imaging System

To enhance the accuracy of face recognition technology in real-world scenarios, it is necessary to train deep learning models on datasets that contain a large number of labeled human face images under multiple poses, lighting, and accessory variations. In this paper, we introduce a novel acquisition system named the Poliface. This system can capture multiple high-resolution images simultaneously around the human head. We designed this system with a well-built aluminum structure, control electronic circuits, and high-performing in-house software. The results demonstrate the precise operation and exceptional stability of this system. Using this Poliface system, we have collected over 6 million photos, which can be used to train and evaluate facial recognition models, and exploited for three-dimensional (3D) virtual face reconstruction.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Facial Reconstruction After Total Resection of Long-Standing Cutaneous Squamous Cell Carcinoma

Facial Reconstruction After Total Resection of Long-Standing Cutaneous Squamous Cell Carcinoma

Adipose tissue: A treasure trove of stem cells for regenerative medicine

Adipose tissue: A treasure trove of stem cells for regenerative medicine Adipose tissue, commonly known as fat, has long been considered a mere energy reservoir. However, recent discoveries have revolutionized our understanding of this tissue, placing it at the heart of advances in stem cells and regenerative medicine. To shed light on these questions, we will rely on the expertise of Doctors Saja Scherer and Giorgio Pietramaggiori from the Global Medical Institute clinic in Lausanne. These two eminent specialists are at the forefront of research and clinical applications of adipose tissue in regenerative medicine. Dr. Saja Scherer, a renowned plastic surgeon, is recognized for her innovative work on the use of adipose tissue in facial reconstruction and rejuvenation. Her research has contributed to improving fat grafting techniques, thus optimizing results for patients.

Anthropological and forensic significance of facial soft tissue thickness in Montenegrin population

A lack of soft tissue leads to difficulties in facial reconstruction and further identification in the absence of DNA (deoxyribonucleic acid), finger print and dental data. If these data are not available, then identification based on facial soft tissue thickness (FSTT) is the next reliable method. There is no data in the literature about facial soft tissue thickness in Montenegrin population. Once the measurement is performed, a software algorithm based on the multidetector computerized tomography (MDCT) imaged bone structures and use of FSTT would be able to provide a useful picture of the face for identification purposes. This prospective research was performed by MDCT head examinations of 83 adults aged 18–85, living in Montenegro. The FSTT was measured at eight central points (glabella (GL), nasion (NA), rhinion (RHI), mid-philtrum (MID), upper lip (UL), lower lip (LL), mental eminence (ME), and the point beneath the chin (BC)), and five bilateral points (frontal tubers (FT), supraorbital (SO), external orbital marginal point (EX), zygomatic arch (ZY), and middle masseter (MST)). It was observed that the points RHI, MID, UL, LL, ME, FT, SO and MST are thicker in men compared to women. With an increase in BMI, FSTT in the central points also increases, as well as bilaterally at the ZY, FT, SO and MST points. With aging, there is an increase of the thickness of the FSTT at the RHI and bilaterally at the EX and ZY, while at the MID, LL and MST, the thickness decreases with aging, in both sexes.

MPF-GAN: an enhanced architecture for 3D face reconstruction

MPF-GAN: an enhanced architecture for 3D face reconstruction

Facial reconstruction with thinned anterolateral thigh free flap

Facial reconstruction is challenging for plastic surgeons, as it can be difficult to decide the best approach. One technique that has been widely used is the anterolateral thigh (ALT) flap due to its numerous benefits. However, its thickness can be a drawback, especially regarding facial reconstruction. The thinning technique is not a new novel, but how to apply it to the ALT flap to get the best result hasn’t been reported yet. Our study involved 117 patients, and we used 73 thinned ALT flaps to determine the best method to increase the flap’s safety. After thinning, we significantly reduced the flap’s thickness from an average of 22.5 mm to 5.9 mm, making it more suitable for contouring purposes. We apply a thinned ALT flap for coverage, contouring, and recreating the facial 3D structure. The 12/45 flap has the chance to make the multiple-paddle ALT flap, which helps to reconstruct difficult positions even more flexibly. The key to successfully thinning the ALT flap is understanding the perforator’s structure and pathway through the fascia. With the thinning technique, we have overcome the limitations of the flap’s thickness, making it suitable for use in whole-body reconstruction. The ALT flap can overcome the restriction of its thickness and can be applied even more extensively in whole-body reconstruction.

Superthin Anterolateral Thigh Flap for Head and Neck Reconstruction.

This study was performed to clarify whether the superthin anterolateral thigh (ALT) flap is an appropriate choice for head and neck reconstructions requiring thinner and more pliable flaps. Data of patients who underwent head and neck reconstruction from January 2020 to December 2022 were retrospectively collected. Nine patients (4.2%) underwent reconstruction with a superthin ALT flap. All the flaps survived with no cases of total or partial necrosis. Six patients treated with superthin ALT flaps and 15 patients treated with conventional ALT flaps who underwent oral cavity reconstruction were compared. The mean body mass index was significantly higher in the superthin flap group than in the conventional ALT flap group (25.2 vs 21.2kg/m2, respectively; P = 0.04). The rate of postoperative complications requiring debridement was 0% and 13% (P = 0.37). The mean postoperative Hirose score was 9.7 and 8.7 (P = 0.17). The mean postoperative Functional Oral Intake Scale score was 6.7 and 5.9 (P = 0.12). Secondary flap refinement surgery after facial skin reconstruction was performed in 0 of 2 patients (0.0%) in the superthin flap group and 4 of 52 patients (7.7%) in the conventional ALT flap group (P = 0.04). Oral cavity reconstruction with superthin ALT flaps did not increase the incidence of postoperative flap necrosis and resulted in comparable postoperative function. In addition, superthin ALT flaps did not require additional flap refinement surgeries after facial skin reconstruction. The superthin ALT flap is a safe and reliable choice for obese patients with thick thigh subcutaneous tissue.

Role of Free Flaps in Facial Burn Reconstructions

AbstractTraditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures. We report the role of free flaps in postburn facial reconstructions, excluding neck and scalp burns.Sixteen free flaps used for postburn facial reconstructions were reviewed retrospectively, during the period between 2003 and 2023. The etiology, indications, timing, location, choice of the flap, type of reconstruction, and outcomes were analyzed. Indications and type of reconstructions were categorized to correlate with flap choice.The age of the patients ranged between 8 and 40 years. The etiology included electrical burns in six cases, flame burns in eight cases, and acid burns in two cases. Nine defects were in the central part of the face including the nose and the chin. Two primary and 14 secondary reconstructions were performed using free flaps from lateral thigh in 11 cases, lateral arm in 2 free flaps cases, radial forearm in 2 free flaps cases, and the posterior auricular flap in 1 case. There were no total flap failures. Secondary procedures were needed in 10 of 13 evaluable patients.Free flaps provide a good and safe option for selective postburn reconstructions in the face. The choice of flap mainly depends on the indication and type of reconstruction needed, apart from the availability of donor tissue and the surgeon's preference. Complex reconstructions may need larger and composite flaps to replace the components. Multiple secondary procedures are needed to achieve the objectives.

Scalp defect associated with extensive fibrosis of artificial dura requiring modified closure

Background A variety of methods are available for scalp defect closure and necessitate extensive planning. Superficial temporal artery (STA) based local flaps are widely used in the field of scalp and face reconstruction because of their flexibility and rich vascularity. Rotation and transposition techniques are commonly used in the area, however at times result in excessive tension. V-Y advancement allows tension-free closure with reduced post-operative complications. Case presentation A case of scalp defect post multiple craniectomies for a traumatic head injury complicated with subgaleal collection and poor wound healing in a 29-year-old male, is reported. Due to the nature of defect, with underlying fibrosis and previous artificial duraplasty, along with location in the frontotemporal region, a local STA based flap closed in a rotation, transposition and unilateral V-Y advancement pattern was used. Conclusion The challenges encountered in wound closure of complicated post-traumatic and multiple craniectomy cases can be overcome with a modified combined approach which achieves optimal wound closure. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1227-1232