Restoration Of Facial Contour Research Articles

An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique.

The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach. This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment. Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume. The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Esthetic restoration of progressive hemifacial atrophy (Parry-Romberg disease) by free fat grafting using computerized-assisted mapping.

This study aimed to evaluate the use of fat grafting enriched with platelet-rich plasma through a computerized-assisted mapping for esthetic restoration in progressive hemifacial atrophy (Parry-Romberg disease). This prospective study was conducted on 53 patients presented by Parry-Romberg disease and was corrected by facial fat grafting (FFG) enriched with platelet-rich plasma (PRP). A computerized software program was used to design a detailed map to achieve clinical symmetry with fat grafting application, as the anatomical subunits direct 3-dimensional volumetric symmetric, and compartments direct isolated recipient-specific grafting. Also, volumetric asymmetry was assessed through outlines of facial contour, projection, and proportions for both sides and comparing the mirror image of unaffected side as a template. Objective ultrasound and photogrammetric measurements showed a significant improvement in facial symmetry postoperatively compared to preoperative (P < 0.05), with no significant differences between 12 and 18months after surgery. The FACE-Q score regarding comparison before surgery and 18months after surgery showed a statistically significant improvement in all modules (P < 0.001) with overall satisfaction concerning outcome of 82.7 ± 0.8. Enriched fat grafting with platelet-rich plasma (PRP) is a good alternative to reconstruct soft tissue defects for patients with progressive hemifacial atrophy (Parry-Romberg disease) with a minimally invasive approach and low complications. It provides volumetric replacement, enhancement of skin texture, and improvement of hyperpigmentation with restoration of facial contour for an esthetic pleasing appearance. Isolated replacement in accordance with the anatomical facial subunits and fat compartments allows three-dimensional reconstruction and maximizes fat retention.

The Accuracy of 3D Surgical Design and Simulation in Prefabricated Fibula Free Flaps for Jaw Reconstruction

The ideal jaw reconstruction involves the restoration and maintenance of jaw continuity, jaw relations, joint alignment, and facial contour, and, most importantly, dental occlusal reconstruction. One of the essential requirements of achieving a consistent functional outcome is to place the bony reconstruction in the correct three-dimensional position as it relates to the other jaw segments and dentition. A protocol of occlusion-driven reconstruction of prefabricated fibular free flaps that are customized to the patient with surgical design and simulation (SDS)-planned osseointegrated implant installation was developed by our institution. This innovation introduced significant flexibility and efficiency to jaw reconstructions, but functional and cosmetic outcomes were dependent on the accuracy of the final reconstructions when compared to the SDS plan. The purpose of this study was to examine the accuracy of the SDS-planned fibular flap prefabrication in a cohort of patients undergoing jaw reconstruction. All patients that had undergone primary jaw reconstruction with prefabricated fibular free flaps were reviewed. The primary outcome of this study was the accuracy of the postoperative implant positions as compared to the SDS plan. A total of 23 implants were included in the analysis. All flaps survived, there was no implant loss postoperatively, and all the patients underwent all stages of the reconstruction. SDS planning of fibular flap prefabrication resulted in better than 2 mm accuracy of osteointegrated implant placement in a cohort of patients undergoing jaw reconstruction. This accuracy could potentially result in improved functional and cosmetic outcomes.

Restoring Facial Contour and Harmony Using Biphasic Calcium Phosphate Bioceramics.

Background:The restoration of facial contour is one of the pillars for the treatment of facial disharmonies and deformities. Fat transplantation and fillers have been widely used to improve the positioning of soft tissues, which are, however, directly related to the conditions and positioning of the underlying bone tissue. Recontouring of the latter has been performed using osteotomies and several types of bone grafts or biomaterials, as inlay or onlay grafts/implants. Here, biphasic calcium phosphate bioceramics were applied in a series of cases, their long-term results are shown, and their advantages, discussed.Methods:A retrospective analysis of 20 patients, who were subjected to facial recontour with onlay implants of biphasic calcium phosphate bioceramics, is reported. Patients were seeking to improve facial harmony due to congenital deformities, trauma, tumor resection or signs of aging, and were followed for up to 16 years. Clinical data, radiographic images, and information regarding pain and other findings were retrieved from medical records.Results:Six patients were men and 14 were women. Their ages ranged from 19 to 64 years. Bioceramics were implanted under the periosteum through external or intraoral incisions. Some patients underwent combined procedures, such as rhinoplasties or facial lifting. None of the patients presented exacerbated inflammation or pain. One of them had infection in the intraoral incision, which was resolved with medication.Conclusion:All patients had improved facial contours following the use of bio-ceramics to augment bone tissue and presented stable results at long-term evaluation.

The surgical management of extra-cranial trigeminal nerve palsies: A retrospective case series

To assess for functional improvement in outcomes following supermicrosurgical restoration across a cohort of patients with a spectrum of trigeminal nerve disorders. In a retrospective case series over three years (2016-18), twenty patients were included in a cohort of trigeminal nerve palsy patients. Eleven patients with corneal anaesthesia underwent corneal neurotisation procedures and were followed up using Cochet-Bonnet aesthesiometry. Six patients with sensory trigeminal nerve injuries had direct nerve coaptation and neuroma excision. Three patients with trigeminal motor nerve palsies were followed up with photography for contour improvement. Regarding corneal neurotisation, there was evidence of significant improvement in protective corneal sensation and also blinking frequency. Regarding facial sensory disturbances, all patients had full resolution of painful trigeminal neuroma symptoms. In two cases of iatrogenic trigeminal motor palsies with contour defects, adipo-fascial variants of the superficial circumflex iliac artery (SCIP) free flap achieved excellent restoration of facial contour in lieu of facial lipofilling. In another case of a necrotising infection of the head and neck with loss of all masticatory muscles, a free functional muscle using a chimaeric vastus lateralis-ALT flap was used to restore masticatory and facial movement in a single stage procedure. Using combinations and permutations of current surgical techniques, it is possible to successfully restore both form and function for patients with sensory as well as motor trigeminal nerve palsies. This sets a precedent for the expansion of cranial nerve surgery as an evolving sub-speciality.

The Role of Folded Multi-Island Vertical Rectus Abdominis Myocutaneous Flap in Reconstruction of Complex Maxillectomy and Midfacial Defects.

The rationale and outcomes for reconstruction of complex maxillectomy and midfacial defects using a folded multi-island vertical rectus abdominis myocutaneous free flap (MI-VRAM) are analyzed in this study.A retrospective review of prospectively collected database was conducted on all VRAM free flaps used in head and neck reconstruction from 2013 to 2019. A total of 39 cases were identified, of which 21 patients underwent immediate VRAM flap reconstruction for complex maxillectomy and midfacial defects. Variables including age, sex, pathologic subtypes, tumor staging, type of resection, defect classification, adjuvant therapy, complications, follow-up time, and reconstructive details were collected.Single skin-island VRAM was used in 10 (47.6%) patients. Eleven (52.4%) patients required the use of folded MI-VRAM flap. In 6 (28.6%) patients a triple skin-island VRAM was used and 5 (23.8%) received a double skin-island VRAM. The average size of harvested skin paddle was 15 × 7.2 cm. Secondary flap contouring was required in 6 (28.6%) patients. There were no cases of total flap loss and no major donor site complications recorded.Folded MI-VRAM flap is a reliable method for reconstruction of complex maxillectomy and midfacial defects. It provides multiple independent skin islands with excellent plasticity and abundant volume of tissue for restoration of facial contours.

Treatment of extensive tumors of the jaws by hemimandibuloectomy with simultaniouse reconstruction of the mandible, arthroplasty of temporomandibular joint, orthopedic rehabilitation supported by dental implants

Background. Reconstruction of subtotal and total defects of maxillofacial region after ablative tumor surgery is a challenging task of reconstructive surgery. The “golden rule” is maintaining of radicalism of ablative surgery as well as appropriate surgical reconstruction and prosthodontic rehabilitation, that allows patient return to normal life. Wherein reconstructive procedure is focusing on restoring of mandibular continuity by the means of different flaps and grafts, while prosthodontic rehabilitation is performing after some period of time (usually around year) by the means of removable and non-removable prosthodontic devices. Non-removable device requiring dental implants insertion into grafted material followed by period of osteointegration, that is requiring some time as well. However, within this period of time one could observe significant soft tissue deformity.The objective is to improve the outcomes of surgical reconstruction of extensive defects of the mandible and to carry out rapid prosthodontic rehabilitation supported by dental implants by application of 3D preoperative planning and navigation devices.Clinical case. Forty-nine years-old female patient with recurrent ameloblastoma, that affects vertical and horizontal ramus of the mandible. Within virtual preoperative planning one performed: resection of the mandible associated with exarticulation of condylar head, virtual plate bending according to contours of the mandible (that were determined by application of “mirror” function of virtual planning software), arthroplasty of temporomandibular joint, determination of donor site on fibula bone, osteotomy of fibula free flap, positioning of dental implants, transferring of composite flap and it’s fixation by reconstructive plate. According to acquiring data one performed fabrication of patient specific navigation guides for both fibula flap segmentation and dental implants positioning. Surgical procedure included single-step tumor ablation and exarticulation of condylar head, reconstruction of defect by the means of osseo-myo-cutaneous fibula free flap, that was pre-implanted by dental implants, total joint reconstruction by titanium condylar head and polypropylene fossa, fixation of the flap and condylar head in recipient site by the means of prebended reconstructive plate, as well as insertion of non-removable bridge prosthodontic device. Postoperative result was asses clinically and radiologically. No significant postoperative complications occurred. Restoration of facial contours, mouth opening, I class occlusion, as well as adequate meal and speech were detected. Postoperative radiological investigation revealed adequate positioning of dental implants within neo-mandible, as well as positioning of artificial joint.Conclusion. In cases of extensive tumors of the jaws single-step ablative surgical procedure, reconstruction of missing anatomical structures of the jaws and simultaneous prosthodontic rehabilitation allows to prevent possible deformities of the soft tissues and due to rapid restoration of vital functions has great impact to quality of patient’s life. Adequacy of performing procedures could be reached by implementation of virtual preoperative planning and fabrication of patient-specific surgical guides.

Comprehensive Three-Dimensional Technology Strategies for Autologous Free Fat Graft in Parry-Romberg Syndrome

Autologous free fat graft is a widely accepted method of facial contour restoration in Parry-Romberg syndrome (PRS); however, complex and unpredictable facial anatomy can render this surgery extremely challenging. The integration of 3-dimensional (3D) technology strategies as a method to enhance surgical aesthetic outcomes has been demonstrated.A retrospective chart review was performed for PRS with autologous, free fat graft between 2016 and 2017. Based on 3D volumetric facial analysis and presurgical simulation, a 3D printed fat graft guide was produced. Surgical outcomes were analyzed by volumetric measurements of the upper, middle, and lower face segments.A total of 9 patients were included in the study. Their upper and middle facial volumes before and after the procedures showed statistically significant volume augmentation (upper face, P = 0.004; middle face, P = 0.002) 6 months postoperatively (T1). Facial asymmetry was also statistically significantly corrected (middle face P = 0.012; lower face P = 0.025) at 1 year after the procedure (T2).The advantageous application of 3D comprehensive technology for aesthetic improvements in patients with PRS with autologous, free fat graft treatment has been demonstrated. Precise preoperative planning based on simulations and postoperative 3D volumetric analyses can help adequately predict fat graft strategies.

Assessment of functional outcome after parotidectomy reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done in the department of Otorhinolaryngology &amp;amp; Head-Neck Surgery. Total number of patients with parotid tumours were 24 in each group namely- Group A: Patients undergoing parotid surgery without reconstruction. Group B: Patients undergoing parotid surgery with reconstruction using superiorly based sternocleidomastoid muscle flap. All patients were followed and analyzed on 6 weeks, 6 months and 1 year postoperatively on the basis of patient’s satisfaction, cosmesis, subjective Frey’s syndrome, retromandibular and pre-auricular depression using visual analogue scale. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In Group A, subjective Frey’s syndrome was present in 8.3% patients from 6 month to 1 year. In contrast, in Group B, it remain absent in all patients at all periods. In Group A, preauricular depression was present in 79.2% patients in immediate postop and 95.8% patients from 6 week to 1 year. In contrast, in Group B, it was present in only 4.2% patients at all periods. In Group A, retromandibular depression was present in 70.8% patients while in Group B, it was absent in all patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The superiorly based SCM flap for reconstruction of defect following superficial or total parotidectomy improves the final outcome in terms of the facial deformity (pre-auricular, retro-auricular depression) and lowers the incidence of Frey’s syndrome.&lt;/p&gt;

Maxillectomy and Quality of Life: Experience from a Nigerian Tertiary Institution.

Introduction:Maxillectomy is a surgical procedure for managing tumors affecting the maxilla; the goal of maxillectomy however should not be limited to tumor extirpation but should include restoration of oronasal function and facial contours, as failure to do these may give rise to psychosocial and functional challenges. This study aimed to appraise the pattern of maxillectomies, challenges of management, and quality of life (QOL) of a proportion of the study population.Materials and Methods:This was a cross-sectional study carried out at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan. Patients’ case files from year 2000 to 2016 were retrieved and reviewed. Data extracted for analysis included age, gender, site of lesion, and histologic diagnosis; lesions were grouped as benign or malignant. Contacts were made with patients or their next of kin for a clinic review appointment where QOL was assessed with the University of Washington Quality of Life version 4 Questionnaire. Data were analyzed and result presented as means and frequencies.Results:Out of the 78 cases of maxillectomy recorded in the department within the study period, records were available and adequate in 67 cases. There were 37 (55.2%) females with a mean age of 35.88 ± 14.9 years. Swelling was the most common reason for presentation (63, 94%). The mean period between onset of disease and presentation for treatment was 3.66 ± 3.35 years. Distribution of lesions was benign 35 (52.2%) and malignant 32 (47.8%). Hemi-maxillectomy was the commonest surgical procedure (23, 34.8%). While majority had some prosthetic rehabilitation, 31 participants (48.5%) obtained no prosthesis. Eight participants gave scores of ≥75% when comparing their present health-related QOL (HR-QOL) with a month before surgery; the overall QOL was ≥60%. However, HR-QOL and overall QOL in the last 7 days before assessment were rated as good in 55.6% and 66.7%, respectively. Chewing was the most important domain to participants.Conclusion:The pattern of presentation and indications for maxillectomy in this series are similar to that from previous studies. The uptake of prosthetic rehabilitation was low and overall QOL was rated as fair. QOL should be considered as part of treatment outcome measure for maxillectomy.

RADIOGRAPHIC ASSESSMENT OF MANDIBULAR SYMMETRY FOLLOWING RECONSTRUCTION OF SEGMENTAL MANDIBULAR DEFECTS

Restoration of symmetric facial contours after resection of mandibular tumors is one of the requisites of a successful reconstructive surgery. For unilateral mandibular defects and using the “mirroring” feature available in many surgical simulation software, it is possible to restore the undistorted mandibular contours and bend the reconstruction plate prior to surgery. The aim of this study: is to assess whether pre-bent mandibular reconstruction plates using computer-assisted techniques for post tumor-ablation defects are good enough at restoring mandibular symmetry radiographically. Patients and Methods: eight patients with segmental mandibular post-tumor resection defects, to whom a computer assisted planning and pre-bending of the reconstruction plates were performed; were included in this study. For each patient, on the 3D reformatted image, a midsagittal plane was constructed and the perpendicular distances were measured from the midsagittal plane to the titanium reconstruction plate and to the contralateral intact side on the axial cuts. The mean differences calculated and statistically analyzed. Results: The mean of the differences between the intact and reconstructed sides of the mandible showed normal data distribution. Overall mean among all patients was 0.7225 mm ± 0.24467. One-sample t test against a hypothetical mean difference of 0 mm revealed an extremely statistically significant difference between the intact and reconstructed sides with a p-value < 0.0001. Conclusion: Computer-assisted precontoured mandibular reconstruction plates can be considered to offer a very good degree of symmetry during mandibular reconstruction procedures.

Transnasal endoscopic ultrasound-guided reduction of maxillary sinus wall fracture.

Surgical morbidity from open reduction and internal fixation (ORIF) of maxillary sinus wall fracture often surpasses the benefits of ORIF. Hence, the authors devised transnasal endoscopic-assisted reduction of maxillary sinus wall fracture (TERM) without internal fixation as a minimally invasive surgery for maxillary sinus wall fracture. The purpose of this study was to investigate the feasibility of TERM in cadavers and patients. Six cadavers were dissected to evaluate the feasibility of TERM. In addition, 20 patients with maxillary sinus wall fractures who underwent TERM in a tertiary hospital from August of 2013 to December of 2015 were enrolled in this study. Demographic factors, type of anesthesia, computed tomography (CT) scans, clinical characteristics of patients, and patient satisfaction with surgery were analyzed. Cadaveric study showed that endoscopic inferior meatus antrostomy is a feasible method of approaching the maxillary sinus wall in cadavers. In addition, counterforce could be applied to the maxillary sinus wall by pushing packed Vaseline-soaked gauze or using a zygomatic process approach via a Gillies incision. Clinical experience revealed that patients experienced good facial contour restoration postoperatively. The extent of fractured bony segments was reduced on postoperative CT without complications. Patient satisfaction with TERM was greater than that with ORIF (p=0.031). TERM showed its feasibility in both cadaveric study and clinical study. TERM can be a good alternative to ORIF, especially in patients who are reluctant to undergo a facial incision.

Neck Rejuvenation through the Lateral Platysma Window: A Key Component of Face-Lift Surgery.

Rejuvenating an aged face relies on maintaining facial harmony to provide optimal aesthetic results. Restoration of more youthful facial contours is dependent on blending the aesthetic facial topographic units. Many authors continue to debate the best approach for neck rejuvenation through a medial approach, a lateral approach, or a combination of the two. The authors present their approach to neck rejuvenation through medial platysma plication, inferior release, and lateral platysma window.

The prosthetic rehabilitation of a panfacial fracture patient after reduction: A clinical report

Panfacial fractures involve trauma to the lower, middle, and upper facial bones and often require a team approach for management. Early and complete restoration of preinjury facial contours and function should be the goal of the oral and maxillofacial surgeon and the prosthodontist. When the intraoral landmarks are lost, overall facial anatomic landmarks can be used to restore the oral cavity. A patient with complex clinical panfacial fractures, including a vertically and horizontally malpositioned native alveolar bone and severe facial asymmetry, is presented. A functional and esthetic rehabilitation was successfully accomplished by using a partial removable dental prosthesis retained with telescopic crowns and magnetic attachments in the maxilla and osseointegrated implants to support a definitive dental prosthesis in the mandible.

Autologus fat transfer for restoration of facial contour in "Progressive facial hemiatrophy"

Autologus fat transfer for restoration of facial contour in "Progressive facial hemiatrophy"

Supraorbital Rim Contour Restoration with Porous Polyethylene Implant via Preexisting Scar

Isolated anterior wall fractures with displaced fragments require surgical correction to restore normal forehead contour. The anterior wall is returned to its anatomic position and stabilized with either suture, wire, or metal or resorbable plates, according to the surgeon's desire and the patient's age.1 Treatment principles are emerging from published studies.2 Many cases with solitary depressed anterior wall fractures require anterior wall restoration to obtain aesthetically acceptable contours.3 We present a 40-year-old man who had left supraorbital rim depression caused by blunt trauma 1 year previously. Anterior wall fracture of the left frontal sinus was evaluated with computed tomography (CT; Fig. ​Fig.1).1). He was treated by porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA) sheet implant (1.5 mm thick; 50 mm wide × 76 mm long) via supraorbital preexisting scar to avoid coronal incision (Fig. 1). In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access.3 The patient did not want a coronal incision for the contour restoration surgery with implant. The patient did not want to autolog bone graft for restoration of the supraorbital rim contour due to the graft donor site morbidity. He was treated by porous polyethylene implant. The porous polyethylene implants have biomaterial properties favorable for facial skeletal contour restoration.4,5 The frontal bar depression was accessed by way of preexisting scar (Fig. 1). First, the scar was removed and the subperiosteal space was entered along the supraorbital rim after incision of the periosteum medially (Fig. 1). Supraorbital soft tissues and neurovascular pedicles were carefully lifted out of the depression area. The porous polyethylene sheet implant overlapped the defect of depression edges. The implant was shaped to bridge the defect and was inserted below the periosteum without any fixation with screws or sutures (Fig. 1). Before implantation, the implant was soaked in antibiotic solution containing 1 g ceftriaxone. Oral first-generation cephalosporin was given every 12 hours for 5 days postoperatively. A compressive garment was used to stabilize the polyethylene implant for 1 week postoperatively. No infection was seen in the early or late postoperative period. At 12-month follow-up, the patient did not complain of any disturbance (Fig. 2). We have experienced these rules in our case: Figure 1 Left supraorbital rim depression (top, left). Preexisting scar on the left supraorbital rim (top, right). Preoperative computed tomography (bottom, left). Medpor sheet implant was inserted the subperiosteal ... Figure 2 Late postoperative view of frontal area. Preexisting scar on the supraorbital area should not be exposed to protect the neurovascular bundle, which is important. If access via the preexisting scar is used for contour restoration, preoperative CT evaluation must be precise to calculate the contour of the defect for the alloplastic material. A compressive garment must be used to stabilize the polyethylene implant for 1 week if rigid fixation material is not used to stabilize the alloplastic material. If the surgeon follows these rules, the surgical approach is less invasive and the operation can be performed without problems in selected cases.

Adipofascial perforator flaps for “aesthetic” head and neck reconstruction

Most head and neck reconstructions are performed for wound closure or functional rehabilitation with aesthetic restoration being an important but secondary consideration. Contour deformities in 40 patients undergoing head and neck resections were reconstructed immediately with adipofascial perforator flaps, including 37 anterolateral thigh and 3 deep inferior epigastric perforator flaps. Reconstructions could be grouped into 1 of 3 defect areas: temporal fossa (n = 3), malar cheek (n = 13), and parotid-mastoid (n = 24). The mean time needed for reconstruction in excess of the oncologic resection was 3.1 hours. There were no flap losses. In no case did a complication delay adjuvant therapy and no patient experienced a decrease in level of activity related to donor site morbidity. Immediate restoration of facial contour with adipofascial perforator flaps is warranted in head and neck oncologic patients to help improve self-image and maintain quality of life.

The Use of Implants in Facial Augmentation for Hemifacial Atrophy

The Use of Implants in Facial Augmentation for Hemifacial Atrophy

Gillies Elevation and Percutaneous Kirschner Wire Fixation in the Treatment of Simple Zygoma Fractures: Long-Term Quantitative Outcomes

The objective of zygoma fracture repair is to restore preinjury function and appearance. The optimal surgical technique represents a balance between accurate fracture reduction and soft-tissue morbidity. Fifty patients were eligible for review after treatment for isolated simple zygoma fractures using a combination of Gillies elevation and percutaneous Kirschner wire fixation between 1992 and 2003. Fourteen patients were available for examination at a mean follow-up of 8.7 years. Quantifiable parameters, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured. All patients underwent qualitative assessment by independent, blinded observers. Negative soft-tissue sequelae were recorded. The mean differences between injured and uninjured sides of the face for malar eminence projection, height, and lateral position were 2.5, 2.7, and 2.3 mm, respectively. The mean difference in ocular globe projection was 1.23 mm. When these results were compared with those previously published for open reduction and internal fixation, no statistically significant difference was noted. The qualitative observers were able to identify the affected side 12 percent of the time. Other than a small punctate scar noted in one patient at the Kirschner wire insertion site, no other negative cutaneous or eyelid sequelae were noted. This study objectively shows that Gillies elevation combined with percutaneous Kirschner wire fixation provides facial contour restoration that is not significantly different from that of open reduction and internal fixation, with less soft-tissue morbidity. The technique is safe, easy to learn, and easy to perform, and should be considered in cases of isolated simple zygoma fractures.

Immediate Reconstruction of Mandibular Defects: A Retrospective Report of 242 Cases

This study was conducted to evaluate the effects of routine protocols in immediate mandibular reconstruction. A total of 242 patients who underwent immediate mandibular reconstruction were reviewed retrospectively. The therapeutic evaluation was performed according to outcomes of clinical and radiographic examination. The evaluated contents included facial symmetry, degree of mouth opening, occlusal relationship, and temporomandibular joint symptoms. Statistical analysis was also carried out to compare therapeutic differences between different methods for mandibular reconstruction. SPSS 10.0 for Windows was used for statistical analysis. The follow-up showed satisfactory long-term outcome in 203 patients. Statistical analysis revealed no significant difference in restoration of facial contour among several groups (chi(2) 0.05(15) = 21.93; P = .109 > .05). Ten cases involved serious postoperative complications, including local infection, exposure of rigid fixation plate, and serious pain. Our findings indicate that autogenous bone graft is the best for reconstruction of small mandibular defects. Frozen autogenous lesional mandible plus autogenous iliac or rib graft is recommended for reconstruction of large defects in the mandible. Strict patient selection, careful surgical procedure, and appropriate preoperative and postoperative nursing care are key factors in successful transplantation.