Short Face Research Articles

Comparison of the Short and Full Incision Face Lift on Five Sets of Identical Twins

INTRODUCTION: To compare results of a short scar face lift to a full incision lift in multiple sets of identical twins. There are no prior studies comparing these incisions in identical twins. Here we offer a comparison of the short scar and full incision as performed on four consecutive identical twins and one set of identical triplets, by the same surgeon. METHODS: After obtaining IRB approval, four sets of identical twins and one set of identical triplets (n=11) underwent rhytidectomy between December 2005 and August 2006. Full scar vs. short scar techniques were performed with identical SMAS techniques when appropriate. In the triplets, one patient received a MACS lift while the other two sisters were given SMAS plications. Skin incision length with corresponding SMAS technique selection was determined for each set of twins by the birth order. First born had a full incision lift. Photographic and chart records were reviewed independently at one and five years to compare early and late results. RESULTS: Both the short term and long term results were comparable between the short and long incision techniques used in these identical twins (Figure 1). Total operative times were similar whether the long or short incision was used. While the long incision technique may allow better access to the SMAS, it requires more time to close.Figure 1: Row A depicts the triplets' pre-operative photographs. Row B depicts the triplets' 1 year post-operative photographs. Column 1: Full Incision with SMAS Plication. Column 2: Short Scar Incision with SMAS Plication. Column 3: Short Scar Incision with MACSCONCLUSION: These results suggest that plastic surgeons should possibly consider the benefits of the shorter incision more frequently when formulating a treatment plan. Particularly as the shorter incision seems to yield equivalent results, at least in certain patient populations. The most obvious benefit is avoiding retroauricular scars and not disturbing the hairline behind the ear. Minimal incision surgery also offers less bleeding, is less invasive, and avoids dissection of the thin post auricular skin flap which can be prone to necrosis during the postoperative period. Although there are individuals who benefit from larger long scar incisions, this study supports the use of more conservative, limited incision techniques based on the degree of facial laxity present in each patient.

Facial pattern of patients with post-foramen incisor cleft

OBJECTIVE: The assessment and establishment of the facial growth pattern for patients with a cleft palate. MATERIAL: This cross-sectional retrospective study was based on front and profile photos of a sample of 71 patients at the HRAC-USP, 22 males and 49 females, Brazilians, young adults, with a mean age of 17 years 8 months, without previous orthodontic treatment and no associated syndromes. The method was the subjective facial diagnosis based on technical concepts, that is, the qualitative morphologic analysis of the face through clinical examination. Individuals were classified as Pattern I, II, III, Long Face or Short Face. RESULTS: The distribution found with the frontal morphologic analysis was: Pattern I (69%), II (6%), III (7%), Long (18%) and Short (0%). As for the profile morphologic analysis, the distribution was: Pattern I (35%), II (38%), III (10%), Long (17%) and Short (0%).The distribution observed in the frontal analysis was very positive, since individuals Pattern I prevailed. For the profile evaluation, the anterior-posterior dysplasias were essentially shown, significantly increasing their participation. Long Face Pattern maintained a balance in both ratings and Short Face Pattern was not found in the sample used, probably related to the low prevalence in the general population. CONCLUSION: The prevalence of different Facial Patterns for patients with cleft palate was similar to that found in individuals without cleft.

The Effect of Surgery on Health-Related Quality of Life and Functional Outcome in Patients with Metastatic Epidural Spinal Cord Compression: The AOSpine North America Prospective Multicenter Study

Metastatic epidural spinal cord compression (MESCC) is a common and devastating complication of cancer. Recent studies have provided evidence that in selected patients combined surgery and radiotherapy provides optimal neurological recovery, in particular as assessed by walking function. However, many patients with MESCC have a relatively short life-expectancy and face numerous health challenges. Hence, the impact of surgery on improving quality of life outcomes in the setting of MESCC is less clear. This is a critical issue given the potential impact of combined surgery and radiotherapy on health care utilization given the frequency of this clinical problem.

Neonatal transient distal renal tubular acidosis in a patient with pseudohypoparathyroidism type 1a

Pseudohypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia and hyperparathyroid hormone (PTH)-emia defined by target organ (kidney and bone) unresponsiveness to PTH. Because the clinical symptoms and hypocalcemia appear when the patients are approximately 3 years of age, the clinical features during early infancy remain unknown. An infant female patient had transient renal tubular acidosis (RTA), which improved only with conservative therapy. Thereafter, the patient exhibited the characteristics of Albright’s hereditary osteodystrophy, including short stature, round and puffy face, obesity, and psychomotor retardation. According to the clinical findings of PTH-resistant hypocalcemia, hyperphosphatemia and hyper-PTH-emia, which simultaneously occurred with growth hormone (GH) deficiency and hypothyroidism, the clinical diagnosis of pseudohypoparathyroidism type 1a was made when the patient was 1 year 8 months of age. This is the first report of a patient with pseudohypoparathyroidism who had neonatal RTA. We herein discuss the basic pathogenesis of the coincidental nature of these two problems. This case report might help to elucidate the clinical features of neonatal patients with pseudohypoparathyroidism type 1a.

The Japanese macaque is an endemic species consisting of two subspecies: Macaca fuscata fuscata and Macaca fuscata yakui

The Macaca fuscata yakui (MFY) is indigenous to Yakushima Island and is a subspecies of Macaca fuscata fuscata (MFF), which lives from Honshu to Shikoku and Kyushu, Japan. However the differences in the skull of the MFY and MFF are unknown, despite the different skull sizes. The infraorbital canal (IOC) indicates that the feature of the frontal view reflects the transversal growth of the maxilla of the skull. In this study, we show the IOC structure of the MFF and MFY using a cone‐beam computed tomography apparatus. These specimens are stored in the osteological collections of the Department of Neurology, Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences (Japan). The maximum height of the IOC, the maximum height from the palatine to the inferior border of the center orbital foramen, and the volume of the IOC of the MFF were significantly greater than those of the MFY (p<0.05). We also classified four types of IOC 3D images, a tube‐like shape, funnel shape, pinched shape, and double‐canal type, in these Japanese macaques. However, a double‐canal type separated into two lumens was found in the five cases of MFY (31.3%, 5/16)). These results suggest that the lower face of MFY with a shorter face indicates a need to prepare for a hard diet compared with the MFF and is related to the food preferences between MFF and MYF.

Frontal lobe epilepsy with atypical seizure semiology resembling shuddering attacks or wet dog shake seizures

We report a girl with a drug-resistant frontal lobe epilepsy caused by focal cortical dysplasia, who exhibited uncommon seizures. The seizures consisted of shoulder or whole body shuddering after a short psychic aura and face grimacing. Consciousness was fully preserved. The seizures resembled "wet dog shake" seizures described in rat models of epilepsy or shuddering attacks in infants. EEG findings were inconclusive, however, MRI showed a clear dysplastic lesion in the right frontal mesial and polar structures. The patient underwent an extended lesionectomy guided by neuronavigation and intraoperative electrocorticography. Focal cortical dysplasia type Ib was histologically confirmed and the patient has been seizure-free for the three years following resection. [Published with video sequences].

Effect of the gingival display on posed smile with different facial forms: A comparison of dentists and patients concepts

The aim of this study was to evaluate and compare the importance of amount of gingival display on smile esthetics and facial attractiveness in males and females with different facial forms by orthodontists as well as lay person. Frontal photographs of 18 male and female patients (9 male and 9 female) each, at a posed smile, seeking treatment in the Department of Orthodontics and Dentofacial Orthopedics were obtained. The photographs were divided in 3 groups based on their facial forms (Short face, Average face and Long face) and were altered by moving the dentition within the lip frame of the captured photograph to bring about different gingival display at smile. The pictures were divided into six groups with gingival exposures of 0 mm, 1 mm, 2 mm, 3 mm, 4 mm and 5 mm. The pictures were rated for attractiveness by four sets of evaluators - male and female Orthodontists and male and female lay evaluators. The statistical analysis methods used for the study included Mean score calculation, standard deviation and Analysis of variance: [test (Mono- Variance)]. The Student t test (two tailed, independent) has been used to find the significance of rating scores between lay person and orthodontist, and also between males and females evaluators. No significant difference in ratings of gingival display in the 3 groups of photographs was noted by lay person and orthodontists. The results point to the fact that the influence of amount of gingival display on smile esthetics was independent of the facial form. It was also observed that gingival display of 0 mm to 2 mm was acceptable to both the lay person and the orthodontists. As the amount of gingival display increased, the ratings for facial attractiveness by both orthodontists and lay person decreased. Higher scores were given by both orthodontists and lay person for photographs which showed gingival display of 0-2 mm, suggesting this value to be most acceptable.

Identification of facial shape by applying golden ratio to the facial measurements: An interracial study in Malaysian population

Background:The “golden ratio” is considered as a universal facial aesthetical standard. Researcher's opinion that deviation from golden ratio can result in development of facial abnormalities.Aims:This study was designed to study the facial morphology and to identify individuals with normal, short, and long face.Materials and Methods:We studied 300 Malaysian nationality subjects aged 18-28 years of Chinese, Indian, and Malay extraction. The parameters measured were physiognomical facial height and width of face, and physiognomical facial index was calculated. Face shape was classified based on golden ratio. Independent t test was done to test the difference between sexes and among the races.Results:The mean values of the measurements and index showed significant sexual and interracial differences. Out of 300 subjects, the face shape was normal in 60 subjects, short in 224 subjects, and long in 16 subjects.Conclusion:As anticipated, the measurements showed variations according to gender and race. Only 60 subjects had a regular face shape, and remaining 240 subjects had irregular face shape (short and long). Since the short and long shape individuals may be at risk of developing various disorders, the knowledge of facial shapes in the given population is important for early diagnostic and treatment procedures.

Reduced bone morphogenetic protein receptor type 1A signaling in neural-crest-derived cells causes facial dysmorphism.

SUMMARYBone morphogenetic protein (BMP) receptor type 1A (BMPR1A) mutations are associated with facial dysmorphism, which is one of the main clinical signs in both juvenile polyposis and chromosome 10q23 deletion syndromes. Craniofacial development requires reciprocal epithelial/neural crest (NC)-derived mesenchymal interactions mediated by signaling factors, such as BMP, in both cell populations. To address the role of mesenchymal BMP signaling in craniofacial development, we generated a conditional knockdown mouse by expressing the dominant-negative Bmpr1a in NC-derived cells expressing the myelin protein zero(Mpz)-Cre transgene. At birth, 100% of the conditional mutant mice had wide-open anterior fontanelles, and 80% of them died because of cleft face and cleft palate soon after birth. The other 20% survived and developed short faces, hypertelorism and calvarial foramina. Analysis of the NC-derived craniofacial mesenchyme of mutant embryos revealed an activation of the P53 apoptosis pathway, downregulation of both c-Myc and Bcl-XL, a normal growth rate but an incomplete expansion of mesenchymal cells. These findings provide genetic evidence indicating that optimal Bmpr1a-mediated signaling is essential for NC-derived mesenchymal cell survival in both normal nasal and frontal bone development and suggest that our model is useful for studying some aspects of the molecular etiology of human craniofacial dysmorphism.

Skeletal stability after inferior maxillary repositioning without interpositional graft

True vertical maxillary deficiency is a characteristic of short face syndrome. In these patients, inferior repositioning of the maxilla (IRM) is indicated to improve facial aesthetics and function, but this procedure has been described as the most unstable. The aim of this study was to evaluate the long term, post surgical stability of IRM, fixed with four 2.0mm L-shaped miniplates, without any type of graft. A cephalometric study was performed, analysing linear measurements (anterior nasal spine, the A point, top of the incisor, top of the buccal-mesial cusp of the first molar, and posterior nasal spine on an X–Y coordinate system) traced immediately preoperatively, immediately postoperatively and at least 6 months post operatively. Eight young adult patients who underwent IRM were studied. The average results of this study were: surgical movement of 4.65mm at I point, 5.32mm at anterior nasal spine (ANS) point, and 4.70mm at A point and relapses of 1.60mm (35%), 2.23mm (43%) and 2.10mm (46%), respectively. It was concluded, that IRM using this type of internal rigid fixation without graft is unstable.

Tipo facial e postura de cabeça de crianças respiradoras nasais e orais

To verify the facial type and the head posture of nasal and mouth-breathing children from habitual and obstructive etiologies, as well as to correlate the morphological facial index to the head angulation position in the sagittal plane. Participants were 59 children with ages between 8 years and 11 years and 10 months. All subjects were undergone to speech-language pathology screening, otorhinolaryngologic evaluation, and nasopharyngoscopy, allowing the constitution of three groups: nasal breathers--15 children; mouth breathers from obstructive etiology--22 children; and habitual mouth breathers--22 children. In order to determine facial type and morphological facial index, the height and the width of the face were measured using a digital caliper. The head posture was assessed through physical examination and computerized photogrammetry. It was verified the predominance of short face in nasal breathers, and long face in mouth breathers. There was an association among facial type and breathing mode/mouth breathing etiology: the brachyfacial type was more frequent among nasal breathers, and less frequent in subjects with obstructive nasal breathing. Head posture was similar in all three groups. No correlation was found between morphological facial index and head posture. The brachyfacial type favors the nasal-breathing mode and the head posture is not influenced by breathing mode and by the etiology of mouth breathing, as well as it is not related to facial type.

Early Orthopedic Treatment and Mandibular Growth of Children with Temporomandibular Joint Abnormalities

In patients with pathology of the temporomandibular joint (TMJ) or abnormal development in the TMJ area, a growth disturbance of the lower face will develop. The deviating growth is characterized by asymmetry if the affliction is unilateral and a retrognathic or even micrognathic mandible if bilateral, with the mandibular growth characterized by a posterior (clockwise) rotation. The short condyle and ramus result in a short posterior face height, resulting in decreased eruption of the posterior teeth and vertical development of the alveolar process. An early treatment, with the goal of supporting the symmetric growth, avoiding compensations, and providing space for normal development of the dentoalveolar area can be an option in which functional and distraction osteogenesis techniques can be combined, increasing the efficacy of treatment. It is obvious that the aim of correcting abnormal growth can lead to an extensive and complicated treatment with a high burden for the patient, and care must be taken to consider a long-term plan that is as comprehensive and effective as possible while avoiding too high a treatment burden for the patient. We suggest a treatment regime combining functional treatment and distraction osteogenesis for the management of asymmetries and mal-development of the mandible and related structures in patients with TMJ pathology.

Concordância dos ortodontistas no diagnóstico do padrão facial

OBJETIVO: avaliar a concordância de ortodontistas treinados no diagnóstico do Padrão Facial, por meio da avaliação morfológica da face. MÉTODOS: foram utilizadas fotografias faciais de frente, perfil e sorriso de 105 indivíduos selecionados aleatoriamente entre pacientes que procuraram tratamento ortodôntico, as quais foram enviadas a ortodontistas treinados na classificação do Padrão Facial. A concordância intraexaminador, dos examinadores com o Padrão-Ouro e interexaminadores foi avaliada por meio do Índice Kappa. RESULTADOS: a concordância na avaliação intraexaminador foi quase perfeita, com Índice Kappa 0,85. A concordância entre os examinadores e o Padrão-Ouro foi moderada (Kappa 0,48), sendo mais alta no Padrão I (Kappa 0,62) e mais baixa no Padrão Face Curta (Kappa 0,33). A concordância entre os examinadores foi substancial (Kappa 0,61), mais alta que a concordância com o Padrão-Ouro em todos os Padrões. CONCLUSÃO: os critérios utilizados pelos examinadores para determinação do Padrão Facial foram os mesmos na primeira e na segunda avaliação. A concordância entre os examinadores e o Padrão-Ouro é moderada, e eles apresentam maior concordância entre si que com o Padrão-Ouro.

Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS

Objectives For experienced personnel endotracheal intubation (ETI) is the gold standard to secure the airway in prehospital emergency medicine. Nevertheless, substantial procedural difficulties have been reported with a significant potential to compromise patients’ outcomes. Systematic evaluation of ETI in paramedic operated emergency medical systems (EMS) and in a mixed physician/anaesthetic nurse EMS showed divergent results. In our study we systematically assessed factors associated with difficult ETI in an EMS exclusively operating with physicians. Methods Over a 1-year period we prospectively collected data on the specific conditions of all ETIs of two physician staffed EMS vehicles. Difficult ETI was defined by more than 3 attempts or a difficult visualisation of the larynx (Cormack and Lehane grade 3, or worse). For each patient ETI conditions, biophysical characteristics and factors of the surrounding scene were assessed. Additionally, physicians were asked whether they had expected difficult ETI in advance. Results Out of 3979 treated patients 305 (7.7%) received ETI. For 276 patients complete data sets were available. The incidence of difficult ETI was 13.0%. In 4 cases (1.4%) ETI was impossible, but no patient was unable to be ventilated sufficiently. Predicting conditions for difficult intubation were limited surrounding space on scene ( p < 0.01), short neck ( p < 0.01), obesity ( p < 0.01), face and neck injuries ( p < 0.01), mouth opening < 3 cm ( p < 0.01) and known ankylosing spondylitis ( p < 0.01). ETI on the floor or with C-spine immobilisation in situ were of no significant influence. The incidence of unexpected difficult ETI was 5.0%. Conclusions In a physician staffed EMS difficult prehospital ETI occurred in 13% of cases. Predisposing factors were limited surrounding space on scene and certain biophysical conditions of the patient (short neck, obesity, face and neck injuries, and anatomical restrictions). Unexpected difficult ETI occurred in 5% of the cases.

Allometry and Interspecific Differences in the Facial Cranium of Two Closely Related Macaque Species

Interpreting evolutionary history of macaque monkeys from fossil evidence is difficult, because their evolutionary fluctuations in body size might have removed or formed important morphological features differently in each lineage. We employed geometric morphometrics to explore allometric trajectories of craniofacial shape in two closely related species, Macaca fascicularis and M. fuscata. These two species exhibit a single shared allometric trajectory in superoinferior deflection of the anterior face, indicating that the differences in this feature can be explained by size variation. In contrast, two parallel trajectories are demonstrated in craniofacial protrusion, indicating that even if they are comparable in size, M. fuscata has a higher and shorter face than M. fascicularis. The degree of facial protrusion is most likely a critical feature for phyletic evaluation in the fascicularis group. Such analyses in various macaques would help to resolve controversies regarding phyletic interpretations of fossil macaques.

Contouring of a Square Jaw on a Short Face by Narrowing and Sliding Genioplasty Combined with Mandibular Outer Cortex Ostectomy in Orientals

A square face is considered unattractive in Orientals; thus, it has become a frequently encountered reason for patients undergoing face contouring surgery. While reviewing the unsatisfactory cases of mandibular reduction, the authors discovered that some failed cases were related to a square jaw on a short face. The conventional procedures fix only the posterior region of the mandible, resulting in increased prominence of the stunted or square chin and short face. Thus, the authors applied a narrowing and sliding genioplasty procedure combined with a mandibular outer cortex ostectomy technique to reshape a wide, weak chin, and a square jaw on a short lower facial contour into a slender and attractive oval face. From July of 2005 to October of 2009, there were a total of 57 patients in this study who underwent a narrowing and sliding genioplasty combined with a mandibular outer cortex ostectomy procedure to correct a square jaw on a short face. The postoperative appearance of all 57 cases showed that the lower face had narrowed and had become softer, slender, and oval, with a slick mental region. Narrowing and sliding genioplasty combined with a mandibular outer cortex ostectomy procedure could efficiently adjust the shape and position of the chin to obtain a good proportion of the lower face and change a square, short face to a slender, oval one in a single operation in accordance with fashionable aesthetics in Orientals.

Masseter length determines muscle spindle reflex excitability during jaw-closing movements

The masticatory muscles are considered to be important determinants of facial form, but little is known of the muscle spindle reflex characteristics and their relationship, if any, to face height. The aim of this study was to determine whether spindle reflexes, evoked by mechanical stimulation of an incisor and recorded on the masseter muscle, correlated with different facial patterns. Twenty-eight adult volunteers (16 women; ages, 19-38 years) underwent 2-N tap stimuli to their maxillary left central incisor during simulated mastication. Reflexes were recorded during local anesthesia of the stimulated tooth to eliminate the contribution from periodontal mechanoreceptors. Surface electromyograms of the reflex responses of the jaw muscles to these taps were recorded via bipolar electrodes on the masseter muscle and interpreted by using spike-triggered averaging of the surface electromyograms. Lateral cephalometric analysis was carried out with software (version 10.5, Dolphin, Los Angeles, Calif; and Mona Lisa, Canberra, Australia). Two-newton tooth taps produced principally excitatory reflex responses beginning at 17 ms poststimulus. Correlation analysis showed a significant relationship between these muscle spindle reflexes and facial heights: specifically, shorter face heights were associated with stronger spindle reflexes. This correlation was strongest between the derived measure of masseter length and the spindle reflex strength during jaw closure (r= -0.49, P= 0.008). These results suggest that a similar muscle spindle stimulus will generate a stronger reflex activation in the jaw muscles of patients with shorter faces compared with those with longer faces. This finding might help to explain the higher incidence of clenching or bruxism in those with short faces and also might, in the future, influence the design of orthodontic appliances and dental prostheses.

Cross-sectional human mandibular morphology as assessed in vivo by cone-beam computed tomography in patients with different vertical facial dimensions

The goal of this study was to look at mandibular cortical bone in live patients using cone-beam computed tomography (CBCT) to determine differences in cortical plate thicknesses and mandibular cross-sectional height and width in patients with different vertical facial dimensions. A total of 111 scanned patients were used. Of these subjects, 43 were included in the average vertical facial dimension group (average face), 34 in the high vertical facial group (long face), and 34 in the low vertical facial group (square short face). Cross-sectional slices of the mandible were developed with the cone-beam scans to evaluate the cortical bone between the dentition at 13 locations. Each section was then measured at 8 sites, which included 1 height and 2 width measures of the cross-sectional area and 5 cortical plate thicknesses. An analysis of variance (ANOVA) with a posthoc Bonferroni statistical analysis was used with a significance level of P ≤0.0167. The long-face group had slightly more narrow cortical bone than the other 2 facial groups at a few selected sites of the mandible. The height of the cross-sectional area of the mandible in the long-face group was shorter posteriorly than in the other 2 groups and became greater toward the symphysis. Mandibular height and width differed more than cortical bone thickness among the 3 types of subjects with different vertical facial dimensions, but statistically significant differences were evident is some sites for cortical bone thickness.

Short Sales, Stealth Trading, and the Suspension of the Uptick Rule

Boehmer, Jones, and Zhang (2008a JF) show that informed short sellers do not stealth trade and hypothesize that because short sellers face execution uncertainty caused by the uptick rule, informed short sellers cannot afford to break up their larger trades into smaller trades in order to hide their information. This paper tests whether short sellers’ propensity to stealth trade is related to the presence of the uptick rule. Contrary to the hypothesis in Boehmer, Jones, and Zhang (2008a), we show that the distribution of information contained in short sales shifts to larger trade sizes, rather than to smaller trade sizes, after the suspension of the uptick rule. We also show that the increase in information contained in large short sales during the post-suspension period is driven by stocks that are most likely to face binding short-sale constraints. Combined, results in this study suggest that the use of larger trade sizes by informed short sellers is affected more by equity borrowing constraints than by regulatory constraints such as the uptick rule.

Narrowing and sliding genioplasty procedure combined with mandibular outer cortex ostectomy technique to correct square jaw in short face

To evaluate the the feasibility and effectiveness of narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy technique to reshape a square jaw in short face. From July 2005 to October 2009, a total of 57 patients received narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure to correct square jaw in short face. All the patients had standard frontal and lateral cephalometric radiographs, panoramic radiographs, and were photographed preoperatively and postoperatively to assess their face contour. The alteration of mandibular angle, mental contour and width of lower face was observed for 6 to 24 months postoperatively. Questionnaires were used to assess the patients' satisfactory. It showed that the postoperative lower face had narrowed and become softer, slender and oval, with a slick mental region. The final aesthetic outcomes were quite satisfactory in all cases from both the view of surgeons and patients. Narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure could efficiently adjust the shape and position of chin to obtain a good proportion of the lower face, and to change square and short face to slender oval one by single operation in accordance with the fashionable aesthetics in orientals.