Clinical evaluation of autologous fat graft for facial deformity: a case series study.

OBJECTIVES: The use of fat grafts in maxillofacial sculpturing is currently a common technique. Unlike fillers, autologous fats unite with facial tissues, but long-term results may still be unsatisfactory. Sharing long-term follow-ups can be helpful in making outcomes more predictable. MATERIALS AND METHODS: The data from patients who were admitted from 2014 to 2016 for fat augmentation were collected. In all cases, fat grafts were injected by blunt cannula using a tunneling technique in different planes. A fan shape order for the malar, periorbital, nasolabial fold, mandibular angle and body, and perioral area was established. RESULTS: Autologous fat was used for different sites of the maxillofacial regions. Of 15 patients, two patients were not satisfied due to fat graft resorption. For this, further injections were performed six months after the first injection using preserved fat grafts. One patient continued to be dissatisfied. There were no other complications related to fat transplants. CONCLUSION: Fat transplantation is a safe, reliable, and non-invasive method for facial contour and facial soft tissue defect restoration. Additional methods such as mesenchymal stem cells along with fat injection increase the survival rate of transferred fat.

Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions.

OBJECTIVES: This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions. MATERIALS AND METHODS: The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant. RESULTS: Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12-8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58-4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79-4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6-4.57 and minimum OR = 1.3, 95% CI: 094-1.8). CONCLUSIONS: The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise.

Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study.

OBJECTIVES: The role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery. MATERIALS AND METHODS: Thirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas. RESULTS: The outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy. CONCLUSION: Based on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.

Health-Related Quality of Life of Persons after Rhinoplasty: A Longitudinal Study among Iranian Population.

INTRODUCTION: Despite the growing number of cosmetic rhinoplasty surgeries in Iran in recent years, there is little information about the effects of this procedure on the subjects' Quality of Life (QoL). This study examined the QoL after rhinoplasty in subjects without nasal obstruction, who wanted the surgery for aesthetic reasons, three and six months postoperatively. AIM: The aim of this study was to assess the changes of QoL in clients who take rhinoplasty. MATERIALS AND METHODS: This was a prospective study conducted in Tehran, Iran. Using convenience sampling, 150 subjects who had undergone cosmetic rhinoplasty from June 2013 to June 2014 were invited to participate in the study. Patients' QoL was measured one week before and three and six months after rhinoplasty, using the Iranian version of the 36-item Short Form (SF-36) questionnaire. Descriptive statistics, Pearson correlation coefficient, one-way ANOVA, paired t-test, and independent sample t-test were used for data analysis. RESULTS: Most of the participants were women (64%), and the mean age was 26.8±5.4 years (range: 18-41 years). The mean QoL scores before and three and six months after rhinoplasty were 67.26±26.01, 68.00±15.7 and 83.65±9.6, respectively. None of the measured demographic characteristics showed any correlation or relationship with the participants' QoL before and after the procedure (p>0.05). CONCLUSION: QoL can be considered as a quality indicator of health care systems. This study shows that the persons' QoL improved six months after cosmetic rhinoplasty.

Correction of maxillofacial deformities in a patient with unilateral coronal craniosynostosis (plagiocephaly): a case report and a review of literatures.

Plagiocephaly (oblique skull) is premature fusion of one of the coronal sutures. Frontal plagiocephaly is a rare congenital deformity in the skull that is the most complicated form of craniosynostosis to treat. Examination of all sutures is necessary for diagnosis of craniosynostosis In this article, a 10-month-old, healthy girl with deformity of the right forehead and orbit that is caused by frontal plagiocephaly and coronal unilateral synostosis is presented. This abnormality was corrected by frontal craniotomy and fronto-orbital complex advancement under general anesthesia. An exact clinical and radiographic (Multislice CT scan with 3-dimensional three dimensional reconstruction) examination with the suitable time of surgery is necessary for diagnosis of skull abnormality and prevention of treatment delay. Furthermore, 3D stereo-photo-grammetry is a radiation-free, non invasive method for evaluating the growth pattern of children in long term.