Third Of Face Research Articles

Comparison of Different 3D Surface Registration-Based Methods to Assess Facial Asymmetry

Background/Objectives: Facial asymmetry is gaining an increasing diagnostic interest in many clinical contexts. Several three-dimensional surface-based methods have been proposed for its assessment; however, they might provide non-equivalent data. Since there is a lack of comparative studies in these terms, this study aims to compare three methods for assessing the asymmetry of the face and facial thirds, thus addressing whether the potential differences can be considered clinically acceptable or not. Methods: Two ‘maxillofacial’ methods based on the trigeminal nerve distribution and one ‘orthodontic’ method based on reference horizontal planes were used to identify the facial thirds on 3D facial models of 80 Italian healthy adults to calculate the asymmetry of the face, and the upper, middle, and lower thirds of the face differently selected by each method. As a measure of asymmetry, the Root Mean Square value was calculated through a mirroring surface-based registration. Intra- and inter-operator reliability was verified for each method. Differences and interchangeability between the methods were tested, respectively, by two-way repeated measures ANOVA (Analysis of Variance) and Bland–Altman and Similarity Percentage model analysis. Additionally, the time required to perform each method was assessed. Results: All methods demonstrated excellent intra- and inter-operator reliability. While the ANOVA analysis found significant differences (p < 0.001) for the majority of facial Regions of Interest between each method, the Bland–Altman analysis revealed that the differences were clinically acceptable (<0.50 mm) for all facial regions between the trigeminal methods, and for the face and the upper third of the face between the orthodontic method, which was revealed to be faster, and the trigeminal ones. The additional similarity percentage model provided visual support for the complete interchangeability of the two trigeminal methods, as evidenced by the lower Coefficient of Variation value. Conclusions: There is no best method for assessing facial asymmetry that applies to all types of clinical settings, as we have shown that different methods may not be completely interchangeable. However, we suggest that the methods based on the trigeminal subdivision can be used interchangeably in contexts where the morpho-functional analysis of maxillofacial regions with different embryological origins is considered. Thus, the clinical setting imposes the choice of one method over another and, as we have pointed out, the consequent comparison of data with those obtained with methods whose interchangeability has been demonstrated.

ORTHOGNATHIC SURGERY ASSOCIATED WITH RHINOPLASTY

Introduction: Orthognathic surgery consists of performing osteotomy of the maxilla and/or mandible with the aim of harmoniously positioning the facial thirds. The treatment of facial deformity can be combined with other aesthetic procedures, carried out concomitantly or at different operative...

The Impact of Standing Electric Scooters on Maxillofacial Fractures: An Italian Multi-Centric Epidemiological Study.

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility's impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths.

Using three-dimensional geometric morphometry for facial analysis in patients with the oculo-auriculo-vertebral spectrum.

To utilize three-dimensional (3D) geometric morphometry for visualization of the level of facial asymmetry in patients with the oculo-auriculo-vertebral spectrum (OAVS). Three-dimensional facial scans of 25 Czech patients with OAVS were processed. The patients were divided into subgroups according to Pruzansky classification. For 13 of them, second 3D facial scans were obtained. The 3D facial scans were processed using geometric morphometry. Soft tissue facial asymmetry in the sagittal plane and its changes in two time spots were visualized using colour-coded maps with a thermometre-like scale. Individual facial asymmetry was visualized in all patients as well as the mean facial asymmetry for every Pruzansky subgroup. The mean colour-coded maps of type I and type IIA subgroups showed no differences in facial asymmetry, more pronounced asymmetry in the middle and the lower facial third was found between type IIA and type IIB (maximum 1.5 mm) and between type IIB and type III (maximum 2 mm). The degree of intensity facial asymmetry in affected middle and lower facial thirds did not change distinctly during the two time spots in all subgroups. The 3D geometric morphometry in OAVS patients could be a useful tool for objective facial asymmetry assessment in patients with OAVS. The calculated colour-coded maps are illustrative and useful for clinical evaluation.

Analysis of Sexual Dimorphic Features of the Jawline and Chin in White Celebrity Faces.

The jawline greatly influences facial shape and contributes to facial dimorphism. Analysis of lower facial shape and sexual dimorphic differences in contemporary attractive white faces can advance the goals of lower facial aesthetics and facial gender-affirming surgery (FGAS). Full-face, front-view photos of 47 white female and 21 white male celebrities were included from a list generated using GQ magazine's Highest Paid Models issue, People Magazine's Beautiful issue (1991-2022), and celebrities featured on lifestyle websites. Facial landmarks were detected through a facial analysis program using Vision framework and MATLAB. After converting pixel distances to absolute distances, lower face measurements were compared between males and females. The mean lower facial height was 6.08cm in females and 7.00cm in males (P value<0.001). The mean bigonial width was 11.21cm in females and 12.30cm in males (P value<0.001). The ratio of facial height to lower facial height was 2.98 in females and 2.76 in males (P value<0.001), signifying that symmetry in facial thirds is more prevalent in attractive female faces, while a longer lower face is more common in attractive male faces. The greatest differences in female and male facial contours were at gonial angles and chin. Analysis of contemporary white celebrity faces demonstrated significantly wider and longer lower facial measurements in males. The overall contour of the female lower face was more tapered at the gonial angles and chin compared to males. These results are important when planning lower facial rejuvenation or FGAS, as lower face size and proportions influence perceived gender and attractiveness.

LeFort III Versus Monobloc Frontofacial Advancement: A Comparative Analysis of Soft Tissue Changes.

The LeFort III and monobloc are commonly used midface advancement procedures for patients with syndromic craniosynostosis with well characterized postoperative skeletal changes. However, the differential effects of these procedures on facial soft tissues are less understood. The purpose of this study was to critically analyze and compare the effects of these 2 procedures on the overlying soft tissues of the face. Frontal and lateral preoperative and postoperative photographs of patients undergoing monobloc or LeFort III were retrospectively analyzed using ImageJ to measure soft tissue landmarks. Measurements included height of facial thirds, nasal length and width, intercanthal distance, and palpebral fissure height and width. Facial convexity was quantified by calculating the angle between sellion (radix), subnasale, and pogonion on lateral photographs. Twenty-five patients with an average age of 6.7 years (range 4.8-14.5) undergoing monobloc (n=12) and LeFort III (n=13) were identified retrospectively and analyzed preoperatively and 6.4±3.6 months postoperatively. Patients undergoing LeFort III had a greater average postoperative increase in facial convexity angle acuity (28.2°) than patients undergoing monobloc (17.8°, P =0.021). Patients in both groups experience postoperative increases in nasal width ( P <0.001) and decreases in palpebral fissure height ( P <0.001). Both subcranial LeFort III advancements and monobloc frontofacial advancements resulted in significant changes in the soft tissues. Patients undergoing LeFort III procedures achieved greater acuity of the facial convexity angle, likely because the nasion is not advanced with the LeFort III segment.

Craniofacial and dental features in children aged 3-5years with congenital Zika syndrome.

Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction, dysphagia among other previously described severe health complications. CZS is usually diagnosed postpartum by evident/apparent neural development problems. Although there are some reports of craniofacial/dentition development in CZS, several clinical oral aspects are still unknown. This study describes some structural and functional characteristics of facial and cranial growth and deciduous dentition in CZS-affected children. Some cranial, facial and dental characteristics were determined in 14 children with CZS aged 3-5years and compared them against 12 apparently healthy children paired by age and gender. Fourteen CZS cases presented microcephaly, maxillary prognathism, altered facial thirds, asymmetric pupillary line, bruxism (p = 0.006), deep and anterior open bite and distal step decidual molar relationship (p = 0.031). CZS children cannot feed by themselves and most cannot walk and have not develop coordinated and intelligible language according to their chronological age. In contrast, controls presented normal skull features, have autonomous locomotion skills, speak intelligible language, feed by themselves, presented a harmonic intermaxillary relationship and have symmetrical facial thirds. Microcephaly, dysphagia, bruxism, mandibular retrognathia, altered facial proportions and malocclusion are the main craniofacial and oral features at CZS. The complications of CZS including those related with the face and the oral cavity are still being identified. This study revealed some cranial, facial and oral features in children affected by CSZ. Interdisciplinary rehabilitation protocols must address these syndromic features that could improve children and parents living conditions.

Facial morphology differences in monozygotic twins: a retrospective stereophotogrammetric study.

To assess soft tissue differences between monozygotic twins (MZ) for the total face and between facial regions using three-dimensional (3D) stereophotogrammetry and quantitative surface-based 3D deviation analyses. The study sample consisted of 14 untreated MZ twins (6 males, 8 females, mean age: 14.75 years) from the archive of Marmara University, Department of Orthodontics. The images were taken by the 3dMDface system, and 3dMDvultus software was used for removal of undesired areas and approximation of the images. Then, stereolithography (.stl) format images were superimposed using the best-fit algorithm using 3-matic software. The face was divided into facial thirds, and upper lip and lower lip + chin regions were created. For the comparison, 3D deviation analyses were performed, and a color map and histogram were created. The data were presented as mean deviation, root mean square (RMS), median, and interquartile range. Between the facial thirds, there was no significant difference in soft tissue differences for mean deviation. A statistically significant difference was found between the upper and lower face for the RMS value. For the comparison of upper lip and lower lip + chin region, the only significant difference was for the RMS. When the data were presented as median and interquartile range, there were no statistically significant differences between any facial regions. Lower facial third and lower lip + chin regions had the greatest differences within MZ twin pairs. The genetic and environmental influences might not be the same for different parts of the face.

Real Face Analysis of Masculinity-Femininity, Facial Ratios, and Attractiveness.

Previous studies have evaluated the influence of facial features in determining male and female sex using prototypical renderings or artificially altered faces in relatively small sample sizes. Using a large set of human photographs and raters, this study hypothesized that certain anatomic facial ratios are associated with perceptions of masculinity/femininity, can interact to predict sex, and are associated with ratings of attractiveness differently in males and females. Ratings of masculinity-femininity and binary self-identification (male or female) were compared with facial anatomic ratios from 827 frontal facial photographs. Ratios were used to characterize facial feature relativity, where higher ratio scores indicated relatively more facial feature representation. Femininity was associated with prominent middle third ratio, nose length, lip vermillion height, eye height, and eye width ratios; masculinity was associated with prominence of the upper and lower facial thirds, nose width, chin height, and philtrum height ratios (all P < 0.01). Subgroup analysis demonstrated many of these relationships persisted when evaluating masculinity in females and femininity in males. Misgendering in males was associated with greater middle third ratio and upper lip ratio, whereas misgendering in females was associated with increased nose width ratio. This study demonstrates associations of femininity with increased horizontal middle third representation, and masculinity was associated with increased upper and lower horizontal representation. These facial ratios interact to predict male and female sex, which could have implications for optimizing facial feminization/masculinization outcomes and building algorithms for artificial intelligence analysis of faces.

Facial Anthropometric Norms of the Young Black South African Woman.

In total, 156 Black female students from Sefako Makgatho University between 18 and 25 years of age, with a normal dental occlusion and a normal body mass index were included in the study. Computer-based photographic analysis of participants' faces in anterior, lateral, and basal views was undertaken under strict studio conditions and compared with international studies. Facial height proportions tended toward a smaller upper facial third in comparison with mid and lower facial thirds. Nasal width was greater than other populations, and exceeded the neoclassical canon of one-fifth of facial width. Nasal tip projection was greater than Congolese and African American counterparts. Vermilion height ratios approximated a ratio of 1:1 with lip protrusion beyond the classical Rickets E-line. The "classical" anthropometric measurements most often quoted in academic literature, although important in their own right, do not consider the distinct differences in facial anthropometric norms between population and racial groups. These differences must be taken into consideration to preserve ethnic traits and optimize aesthetic outcomes.

Facial Asymmetry of Italian Children: A Cross-Sectional Analysis of Three-Dimensional Stereophotogrammetric Reference Values

Reference data on the asymmetry of facial thirds of children is still scarce, although it can offer meaningful comparative information for clinical studies. This study aims to provide reference data on the facial asymmetry of Italian children using a 3D analysis of facial thirds divided according to the trigeminal nerve distribution (upper, middle, and lower). A 3D surface-based approach was conducted on the digital models of the faces of 135 children (74 M, 61 F), acquired by stereophotogrammetry. In addition to sex, two different age classes were analyzed (4–8 years and 9–12 years). For each facial third, the asymmetry was expressed as root-mean-square distance (RMS) by calculating the point-to-point distances between the original and the reflected 3D models. A 3-way ANOVA test verified significant differences between the two sexes, the two age classes, and the three facial thirds (p-value &lt; 0.05), and also their interaction. Significant differences were found between the sexes (females were more symmetric, p = 0.005) and the two age groups (younger were more symmetric p &lt; 0.001). According to Tukey’s HSD post-hoc test, among the thirds, the middle one proved to be significantly more symmetrical (p &lt; 0.001). No significant interaction impacting the asymmetry was found when the main factors were considered in any combination. Reference data on the “normal” facial asymmetry of Italian children was provided for further clinical purposes. Normal children have low average RMS values (0.30–0.51 mm) and younger, in particular females, proved more symmetrical than older children, while among the facial surfaces, the middle proved most symmetrical in both sexes, although with little clinical relevance. Since there is no consensus on the amount of symmetry deemed clinically acceptable, further studies on larger randomized samples are auspicial.

Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal

E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n=77) of all facial injuries, while burn injuries made up of 26.7% (n=28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n=18), oral cavity (25%, n=7), and eye (10.7%, n=7). The majority (81.8%, n=63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n=20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n=8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.

Digital technology in orofacial harmonization

The field of dentistry had its challenges during and after the pandemic crisis for the provision of its services, which led to reconfigure their strategies. The context of the following article aims to demonstrate the importance of the application of a complementary technological tool called odontoangela.com within orofacial harmonization through relationship marketing. Method: The tool was used in a sample of 50 clients-patients within an organization in Valencia, Venezuela. Results: It was shown that the analysis obtained of both dental clinical characteristics and facial thirds through the photographic record, together with the desires and needs expressed through a video before having their first face-to-face consultation, provided significant information to complement a presumptive diagnosis. Conclusion: The use of digital technology can allow the harmonizer the first line of communication via virtual communication with the client-patient, in turn, be a complementary method for diagnosis and planning of the future treatment plan from anywhere, which makes a positive trend in the implementation of strategies aligned towards professional growth and advice to client-patients, which makes, a greater space in the market.

Longitudinal changes of the insertion of the maxillary labial frenum in children and adolescents undergoing orthodontic treatment

This study aimed to evaluate potential vertical changes in the position of the maxillary labial frenum (MLF) insertion in growing children and to compare these changes to the vertical growth of the dentoalveolar process and lower facial third. This retrospective longitudinal study investigated records of 33 healthy children. Dental casts, lateral cephalograms, and photographs were evaluated at pretreatment (T0), posttreatment (T1), and 3-5 years into retention (T2). To evaluate the vertical changes of MLF insertion in relation to the vertical growth of the dentoalveolar process, the palatal plane (PP) was used as a reference. These changes were also compared between different MLF typologies (ascribed as thin or fibrous). The distance from MLF to PP only slightly increased from T0 to T2 by 0.6 ± 0.5 mm (P<0.001), whereas the distance between the incisal edge and PP increased significantly from T0 to T2 by 2.6 ± 0.8 mm (P<0.001). A positive correlation was found (r= 0.94; P<0.001) between the changes from the incisal edge to the PP and the MLF to the incisal edge between T0 and T2. No correlation was found between the change from the incisal edge to the PP and MLF to PP between T0 and T2. Thin MLF types showed a larger increase in distance from their insertion to the incisal edge (2.6 ± 0.8 mm) than thick MLF types (1.8 ± 0.7; P<0.03). The MLF remains stable compared with the PP, whereas the maxillary incisal edge moves away from the PP, indicating increased vertical growth of the alveolar process. Dentists should be aware of those changes before performing interventions such as unnecessary frenectomies.

Using Artificial Intelligence to Quantify Sexual Dimorphism in Aesthetic Faces: Analysis of 100 Facial Points in 42 Caucasian Celebrities.

Sexual dimorphism has been studied in the faces of average populations and worldwide celebrities; however, a focused analysis of attractive Caucasian faces has not been conducted. The study harnesses the power of artificial intelligence (AI) to efficiently analyze these facial patterns in attractive Caucasian male and female celebrities. Twenty-one male and 21 female Caucasian celebrities were selected based on popular editorial rankings, modeling agencies, and casting directors from 2017 to 2022. Frontal photographs of celebrities aged 23 to 42 without facial animation were selected. One hundred facial landmarks were identified using semi-automatic image analysis software consisting of modified Apple Vision (Cupertino, CA) machine-learning algorithms with additional custom landmarks. Measurements were converted to absolute distances by fixing subjects' white-to-white corneal diameters to the validated average in Caucasians. Attractive females had significantly greater upper and middle facial proportions, more uniformly divided facial thirds, and greater canthal tilt compared with males. Attractive males had significantly greater facial height, bizygomatic and bigonial widths, medial and total brow lengths, and alar width than females. The golden ratio (1.618) was observed in the ratio of facial height to bigonial width in females (1.613), and attractive males closely approximated that ratio (1.566). There were no significant differences in interpupillary distances, eyebrow angles, or horizontal palpebral fissure lengths. No faces in either sex exhibited scleral show. The study is the first to utilize AI in quantifying key sexual dimorphisms among Caucasian celebrity faces. Identifying these contemporary patterns may provide valuable considerations in planning facial aesthetic and gender affirmation surgery.

Panorametric study in a paediatric population in Madrid.

The aim of the study was to establish the normality ranges of the linear and angular measurements that can be carried out in orthopantomographies (OPGs) of a paediatric sample from Madrid, according to sex and dentition. OPGs performed in the Radiology Service of the Faculty of Dentistry of the Complutense University of Madrid (UCM) from caucasic children between 4-14 years old were selected. A total of 44 measurements were made in the OPGs, and the sex and type of dentition of each child were recorded. Panoramic Mandibular Index and Antegonial Index were also calculated. Statistical tests were performed with a confidence level of 95% (p < 0.05) and bilateral significance to analyse the differences between sex and type of dentition, and the correlation between the measurements of the right and left sides. A total sample of 160 OPGs (50% boys, 50% girls) were analysed. 16.25% of the sample was in primary dentition, 50% in first phase mixed dentition, 17.5% in second phase mixed dentition and 16.25% in permanent dentition. Statistically significant differences were found with respect to the sex of the subjects in 11 of the measurements; and 44 in relation to the dentition stages of the subjects. A strong correlation is found between the measurements on the right and left sides. The application of panoramic measurements as indicators of normality can help in the detection of craniofacial alterations in growth and development of the lower facial third.

Esthetic preferences of orthodontists, dentists, and plastic surgeons for balanced facial profiles.

The aim of this investigation was to determine whether the facial esthetics of subjects rated as "attractive" can be related to specific cephalometric soft tissue parameters. The profile silhouettes of 100 subjects (45 males and 55 females) were rated by 60 esthetics specialists (20 orthodontists, 20 dentists, and 20 plastic surgeons) using a Likert scale, and 30 of the subjects were selected as being "attractive". The cephalometric measurements of the attractive group were then compared with norms for the general Caucasian population. The effects of specific measured parameters on profile beauty grades were assessed using the median test, and the following variables were found to show significant correlations between the Caucasian norms and the attractive profile group: the ratio of the upper to lower face height (P = 0.011), the ratio of the subnasale - labrale inferius (Sn-Li) and labrale inferius - menton (Li-Me`) lines (P = 0.011), the distance between the chin and the subnasale perpendicular (P = 0.002), upper lip thickness (P = 0.021), soft tissue chin thickness (P = 0.021), vertical height ratio (P = 0.021), and nasolabial angle (P = 0.021). A straight profile with a fuller and more protruded upper lip, a higher nasal tip, and a smaller lower facial third are considered to be the most attractive facial features, and may be useful for improvement of facial esthetics.

Hyaluronic Acid Fillers, Needle Contamination by Fastidious Microorganisms, and Risk of Complications.

Complications are becoming ever more common with the increased use of hyaluronic acid (HA) fillers in aesthetic medicine. Complications due to needle contamination with fastidious microorganisms are no exception. To perform, in a top Italian aesthetic medicine facility, what the authors think is the first monitoring program of microbial needle contamination of cross-linked HA gel fillers after the prefilled syringes with gel residues were stored for retouches after the first aesthetic procedure. Needle contamination monitoring study, performed between January and November 2019, on 35 needles (caliber, 30 and 27 G) stored at 4°C in their resealed filler packages for possible retouch after a first aesthetic treatment involving the middle and lower facial thirds. Women's age: 35 to 70 years old. The search for contaminating agents of the 3 monitored bacterial contaminants ( Staphylococcus aureus , Streptococcus pyogenes , and anaerobes) as well as yeasts and molds always tested negative. In the days and months after treatment, no patients in post-treatment controls showed evidence of infection in the treated areas. The observational retrospective study confirms that good storage conditions, including monitored refrigeration, avoid the risk of contamination of partially used HA gel fillers by fastidious microorganisms.

PROFILOPLASTY

Profileplasty encompasses the study of facial proportions and the treatment of profile disharmonies to achieve a more balanced aesthetic. One of the forms of treatment is the evaluation of facial thirds and angles, and consequently the use of injectable fillers as an option to achieve the beauty standards defined by this science. In this work, a facial analysis was performed using measurements of angles and facial thirds, documented by photographs. Through these results, injectable fillers with Hyaluronic Acid were made at strategic points in order to improve measurements and directing the patient to the beauty standards defined by profiloplasty.

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.