Treatment Of Facial Deformities Research Articles

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 Use of Interlocking Polyetheretherketone (PEEK) Patient-Specific Facial Implants in the Treatment of Facial Deformities. A Retrospective Review of Ten Patients

Polyetheretherketone (PEEK) is a versatile biocompatible material with a wide variety of clinical applications. Multiple-piece 3-dimensionally milled interlocking PEEK patient-specific implants are used in cases with restricted access or around vital structures. The interlocking joints reduce the number of fixation screws required by converting the multiple segments into 1 single implant. Stability of such joints is of paramount importance to prevent complications such as infection and implant extrusion. This retrospective study evaluates the clinical outcomes in the use of multiple-piece 3-dimensionally milled interlocking PEEK patient-specific implants as a treatment for various congenital and acquired facial deformities. Patients' records and clinical interviews were retrospectively reviewed. A total of 10 patients were included; 6 of them (60%) were men. A planning cone beam scan (90%) or computed tomography scan (10%) were obtained following a standard protocol. All treatments were performed by a single surgeon, following a standardized approach. The follow-up time ranged from 11 to 61months (mean=37.1months). No implant exposure, extrusion or removal were reported. Three patients (30%) experienced complications. Recurrent edema was observed in 1 patient (10%), another patient (10%) experienced bilateral mental nerve paresthesia, and the third patient (10%) had recurrent sinusitis, which was successfully treated with functional endoscopic sinus surgery without removing the implant. Within the limitation of this study, 3-dimensionally milled interlocking PEEK patient-specific implants are safe, predictable, potentially save operative time, and readily adjustable. Extra stability and antislippage mechanism can be achieved by using the interlocking joint. Further studies on a larger cohort of patients is needed to confirm these results.

Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants.

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused depositionmodeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.

Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants

Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants

The use of interlocking1 PEEK patient specific facial implants (PSI) in the treatment of facial deformities, an outcome study

The use of interlocking1 PEEK patient specific facial implants (PSI) in the treatment of facial deformities, an outcome study

Osteogenic Distraction in Complex Mandibular Defect

Distraction osteogenesis (DO) is a surgical technique used in the treatment of facial deformities and malformations and also in the treatment of alveolar bone deficiencies. The aim of this paper is to show the case of a patient with partial edentulism in the symphysis area with a severe vertical and horizontal bone deficiency caused by mandibular trauma. At the initial analysis, the patient related a recent history of fracture in symphysis and right angle of the mandible. Treatment had not been entirely succesfull, therefore, after studying the options, we opted for a treatment at different stages: Stage 1, surgery for osteo shynthesis removal, soft tissue preparation and replacement of the posterior margin of mandibular symphysis; stage 2, distraction osteogenesis, performed 3 months after the first intervention and stage 3, distractor device removal and dental implant installation, performed 6 months after the second intervention. We discuss some factors involved in the treatment success.

Planning options of reconstructive and orthognathic operation by means of three-dimensional imaging

We summarize up-to-date planning technics of orthognathic and reconstructive surgery operation which appeared with three-dimensional imaging, using literature data and some clinical examples. In many cases, orthognathic and reconstructive operations mean the only treatment of facial deformity caused by tumour, traumatic injury or congenital anomaly. In this field, radiology plays an important role not only in the diagnosis but also in the planning of the treatment. With the appearance of cone-beam computed tomography (CBCT), the previously used two-dimensional cephalometric analysis on lateral cephalogram was changed for three-dimensional cephalometric measurements. The first step of the adaptation was the lateral and frontal x-ray images generated from the CBCT database and later the volume rendered surface and segmentation technics provided the moving of the facial bones in three dimensions which meant virtual surgical planning. With the development of CAD/CAM technic and the three-dimensional printing, many opportunities became available, such as preoperative bending splints and plates and printed surgical model for the tangible planning. The progress of imaging facilitated the individual, accurate, and reliable planning which significantly determines the success of the treatment. Orv Hetil. 2018; 159(39): 1584-1592.

Study on Three-Dimensional Surgical Simulation and Face Prediction of the Individualized Maxillofacial Soft and Hard Tissue

Three-dimensional 3D modeling, surgery simulation and face prediction of the maxillofacial soft and hard tissue has a great significance for the study of facial growth and development, diagnosis and treatment of facial deformity and postoperative face prediction and treatment evaluation. Based on maxillofacial 3D modeling and measurement analysis, real-time variable model is set up. In virtual environment, image feedback, force and tactile perception in combined together surgical simulation. Furthermore, the system of surgical prediction and postoperative results display is proposed, which has great value and clinical significance.

Study on Three-Dimensional Reconstruction of the Individualized Maxillofacial Soft and Hard Tissue

The three-dimensional modeling of the maxillofacial soft and hard tissue has a great significance for the study of facial growth and development, diagnosis and treatment of facial deformity, postoperative face prediction and treatment evaluation. The key technology of the maxillofacial soft and hard tissue reconstruction is described.

Medical Leeches for Salvage Therapy in Free Flap Treatment of Facial Deformities

Medical Leeches for Salvage Therapy in Free Flap Treatment of Facial Deformities

Miniplacas permitem tratamento eficiente e eficaz da mordida aberta anterior

INTRODUÇÃO: o tratamento das deformidades e más oclusões que incluem mordidas abertas anteriores foi uma das primeiras aplicações de miniplacas como forma de ancoragem ortodôntica. A implementação desse sistema de tratamento reduz o número de pacientes indicados para a cirurgia ortognática e simplifica muitos problemas. Nessa abordagem, os dentes posteriores são intruídos e a mandíbula sofre um giro no sentido anti-horário, diminuindo a altura facial inferior e projetando os pogônios de tecidos duro e mole. OBJETIVO: o presente artigo apresenta os fundamentos da mecânica ortodôntica para correção da mordida aberta anterior e os ilustra com uma série de casos clínicos.

Paul Louis Tessier

Paul Louis Tessier

Paul Louis Tessier

Paul Louis Tessier

Correction of a mandibular asymmetry using a custom-made titanium onlay

The diagnosis and treatment of facial deformities, including mandibular asymmetries, can pose a significant clinical problem. The limitations, accuracy and predictability of treatment options available and the expectations of the patient can further compound this. In this article we present a case of facial asymmetry secondary to mandibular angle deficiency corrected by the manufacture and placement of a custom-made titanium onlay. Although alternative methods were potentially available to correct this deformity, patient factors including occlusion, dental/skeletal relationship and chin position limited our options. Furthermore, construction of the custom-made titanium onlay involved the development of a computer-generated 3D virtual model and computer-aided design and computer-aided manufacture (CAD-CAM) of the inlay. This report demonstrates that this technique can be used successfully to address certain cases of facial asymmetry.

Evaluation of the outcome of treatment of facial deformities due to Recklinghausen’s disease

The aim of the study was to evaluate the outcome of treatment of facial deformities in patients with Recklinghausen’s disease. Twenty-nine patients suffering from Recklinghausen’s disease were treated at the Hospital of Plastic Surgery in Polanica Zdroj in the years 1990–2005. The age of patients when they were first seen was from 1 to 23 years (mean age 11 years). Most of the patients were followed up for 1 to 31 years and were submitted to surgical treatment only periodically. All the patients had facial lesions, including 14 with tumours within the orbits and eyelids. Altogether, 198 partial or complete resections of neurofibromas and corrective procedures were performed (average 6.8 operations per one patient). Nodules on the head, eyelids, cheeks and nose were most commonly resected. Reduction in the tumour mass resulted in improvement of facial symmetry. The resections were often repeated several times in the same area with additional resections in other body areas. Histopathological examinations revealed plexiform neurofibroma in seven cases, while malignant carcinoma was not diagnosed in any of the cases. Three patients developed mild complications (1.5%). Facial neurofibromas occurring in the course of von Recklinghausen’s disease require surgical treatment, which is often multi-stage because of benign but progressive proliferation of tumours. Systematic reduction in tumour mass may decrease the risk of malignant transformation.

The ranking of facial attractiveness.

A method of assessing facial attractiveness is described in which facial photographs were ranked by adults in order from the most to the least attractive. The rankings of a group of normal 10-year-old children were compared to those given to a group of similarly aged patients with repaired clefts. Most previous methods have grouped patients into categories, but this tends to obscure individual differences in facial attractiveness: patients with small differences in appearance are generally placed in the same group. In the ranking technique described in this paper these individual differences were not obscured. Those individuals with repaired clefts were consistently judged as being less attractive than those in the normal group. It is suggested that this method could be further developed to assess the cosmetic benefit produced by treatment of facial deformity.

Mandibulo-facial dysostosis. Analysis; principles of surgery.

Before regarding the treatment of facial deformities in mandibulo-facial dysostosis, the clinical, radiological and anatomical findings are reviewed. The plastic surgical correction of the main deformities are then considered. The aims of the treatment are: close the palpebral coloboma, build the zygomatic bones and zygomatic arches, correct the malformation of the auricles and the macrostomia, re-establish normal dental occlusion if necessary and harmonize the profile by reducing the nose and excessive vertical dimension of the mental symphysis.

Evaluation of Craniofacial Surgery in the Treatment of Facial Deformities

Surgical access to the cranial, orbital, and facial areas, as developed by Tessier, has produced not only definitive repair of previously uncorrectable congenital deformities such as orbital hypertelorism and facial stenosis (e.g., Crouzon's, Apert's syndromes) but also has improved markedly the treatment of traumatic and neoplastic defects. The surgical approach allows complete dissection of facial soft tisses including the orbits from the underlying bones followed by corrective osteotomies and fixation. Mobilization of the frontal lobes through a frontal bone flap exposure may be required. The ramifications of this latest intrusion by surgeons into a previously inviolate anatomic area have involved neurosurgeons, ophthalmologists, anesthesiologists, and dental and psycho-social disciplines. The disciplines of genetics and embryology are being influenced by this new field of surgery, much as the study of immunology was influenced by transplantation surgery two decades ago. This report analyzes a 10 year experience with over 100 patients with emphasis on patient selection by disease, age, intellectual status, morbidity, complications, and the psycho-social reactions of patient and family. Procedures initially planned to correct dental and aesthetic defects are proving beneficial for other functions including hearing, taste and smell, articulation and tongue movement, respiratory function, vision, and possibly bone growth. The development of self image, a normal process always in operation, is also strikingly altered. These operations may last as long as 14 to 16 hours. We have had no deaths or postoperative blindness. One postoperative cerebrospinal fluid leak was successfully repaired. Three partial losses of bone grafts and four instances of late cellulitis have occurred. Prevention of infection seems related to avoidance of dead spaces and primary closure of all mucosal, dural, conjunctival and skin surfaces.

Annual discourse--organ replacement, facial deformity, and plastic surgery.

PLASTIC surgery, second only to obstetrics as the oldest surgical specialty, is tested most rigorously in the treatment of facial deformities. Through the centuries the mutilated nose cut off as punishment for murder, theft, or infidelity,1 the congenital cleft lip,2 and the face eaten by cancer or torn by trauma have forced the reconstructive surgeon to seek imaginative ways to restore both function and an aesthetically acceptable appearance.Whenever possible, surgical repair is performed by joining together adjacent areas; often, however, additional tissues such as grafts of skin, cartilage, fascia, or bone are needed to replace the missing or injured . . .