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OBJECTIVES: To evaluate the prevalence of temporomandibular disorders (TMD) in a monocentric cohort of patients affected by psoriatic arthritis (PsA), and to investigate the accuracy of temporomandibular joint (TMJ) ultrasound (US) compared with clinical evaluation and clinimetric composite index in assessing TMJ involvement. METHODS: We conducted a prospective cohort study of patients diagnosed with PsA who underwent at least one TMJ US examination and maxillofacial surgeon's evaluation between 2018 and 2021. The rheumatology physician's interpretation of each TMJ US exam (presence/absence of TMD) was compared with psoriatic arthritis disease activity indexes and maxillofacial surgeon's clinical judgement (presence/absence of TMD signs and/or symptoms). RESULTS: 142 psoriatic arthritis patients were included. 111 patients were totally asymptomatic for TMD, but 58.5% of them already showed TMJ US changes; moreover, 103 patients passed the maxillofacial surgeon's examination in the absence of any relevant findings but again, of these, 55.3% already presented US signs of TMD. Univariate analysis of subgroups with and without TMJ synovitis and with and without active power Doppler signal showed a significant prevalence of peripheral enthesitic involvement in patients affected by TMD (95.7% vs. 4.3%, p=0.001; and 72.2% vs. 27.3%, p=0.007, respectively). Multivariate regression analysis confirmed the results (p=0.01 and p=0.013, respectively). CONCLUSIONS: Peripheral enthesitic involvement may represent a potential risk factor for the development of TMJ synovitis in PsA patients. Since TMD often develops asymptomatically, TMJ US may detect early signs of TMD, ensuring precocious and adequate management.
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Artrite Psoriásica , Sinovite , Transtornos da Articulação Temporomandibular , Humanos , Estudos Prospectivos , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Artrite Psoriásica/epidemiologia , Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/etiologia , Sinovite/diagnóstico por imagem , Sinovite/epidemiologiaRESUMO
Autologous fat transfer (AFT) is a well-established and safe surgical technique in which autologous fat tissue is injected at a defective site directly after its harvesting and centrifugation. Initially used as an excellent filler for facial enhancement and rejuvenation, AFT has evolved over the years into more complex reconstructive procedures. Autologous fat transfer is now additionally used for correcting and restoring cranial and maxillofacial volume defects resulting from traumas, tumors, or congenital disorders. Apart from being a natural filler, human adipose tissue represents a rich source of mesenchymal stem cells, called adipose-derived stem cells, that exhibit multilineage differentiation potential and secrete several angiogenic and antiapoptotic factors.In this work, the authors will discuss different aspects influencing the final outcome of AFT, on the basis of the major clinical outcomes obtained using this surgical procedure. Starting from preoperative evaluation and planning, donor-recipient sites, and type of anesthesia and infiltration, the discussion will continue by analyzing the methods of adipose tissue harvesting, purification, and processing. Finally, an overview of the type of placement, clinical application, postoperative care, possible complications, fat graft take, longevity, volume maintenance, and future perspectives will be provided.
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Tecido Adiposo/transplante , Face/cirurgia , Regeneração/fisiologia , Rejuvenescimento/fisiologia , Adipócitos/transplante , Contraindicações de Procedimentos , Face/fisiologia , Humanos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do TratamentoRESUMO
Distraction osteogenesis (DO) has been one of the most innovative concepts in cranio-maxillofacial syndromology and surgery over the last 25 years.Early mandibular distraction in severe micrognathia has recently been recognized as an effective treatment option to safely relieve upper airway obstruction associated with mandibular deficiency.An increased incidence in temporomandibular joint complications during DO in neonates has recently been reported, especially in syndromic patients.The authors report 2 children affected by severe micrognathia and severe respiratory distress at birth.Early DO was performed during the first 2 months of the life in another institution with the aim of increasing mandibular length and upper airway size.Both the patients had severe restricted jaw opening after DO and mandibular abnormalities.Temporomandibular joint ankylosis after early mandibular distraction could be a considered a new pathological entity.
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Anquilose/etiologia , Micrognatismo/cirurgia , Osteogênese por Distração/efeitos adversos , Complicações Pós-Operatórias/etiologia , Apneia Obstrutiva do Sono/cirurgia , Transtornos da Articulação Temporomandibular/etiologia , Anquilose/diagnóstico por imagem , Artroplastia/métodos , Criança , Pré-Escolar , Intervenção Médica Precoce , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico por imagem , Síndrome , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To present a case and review the literature on Orbital Radiotherapy (OR) combined with intravenous methylprednisolone, focusing on its late application in patients with long-lasting active Graves' Orbitopathy (GO). Additionally, we suggest emerging perspective for future research in this context. METHOD: Relevant literature (randomized controlled studies, retrospective studies and reviews) was explored on PubMed from January 1973 to January 2024, searching "orbital radiotherapy" & "Graves disease". RESULTS: OR is a well-established second-line treatment for moderate-to-severe active GO, providing response rates comparable to glucocorticoids. Its anti-inflammatory effect makes OR particularly suitable for early active GO, and when combined with glucocorticoids, outcomes are synergistically improved. The emergence of the new Volumetric Modulated Arc Image-Guided Radiation Therapy (VMAT-IGRT) technique enables precise radiation delivery to the target, significantly reducing associated toxicity. This technological advancement enhances the feasibility of radiotherapy in benign diseases like GO. A retrospective study indicated that late OR in patients with long-lasting active GO may improve diplopia and visual acuity, decreasing disease activity. Our case report supports this conclusion. CONCLUSIONS: This report and literature review underscores the importance of considering late OR combined with intravenous methylprednisolone as a viable treatment option for GO patients with prolonged disease activity, emphasizing the crucial role of personalized therapy in managing GO. However, further investigations are warranted to validate this approach in cases of long-lasting active GO.
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Oftalmopatia de Graves , Metilprednisolona , Humanos , Metilprednisolona/uso terapêutico , Metilprednisolona/administração & dosagem , Oftalmopatia de Graves/radioterapia , Oftalmopatia de Graves/tratamento farmacológico , Feminino , Terapia Combinada , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Resultado do Tratamento , Pessoa de Meia-Idade , Glucocorticoides/uso terapêutico , Glucocorticoides/administração & dosagem , Administração IntravenosaRESUMO
Pigmented villonodular synovitis is a benign lesion of unclear etiology involving the synovial membranes of joints, bursae, and tendon sheaths. Its occurrence in the temporomandibular joint is particularly rare. Despite its benign nature, pigmented villonodular synovitis is described as being locally destructive to the surrounding structures. Imaging evaluation and histopathologic examination are crucial for correct diagnosis.The purposes of the surgical treatment are for relief of pain and swelling, improvement of joint function, and prevention of further joint damage.The authors report a case involving an adult male patient; complete excision of the temporomandibular joint lesion through an open arthroplasty approach was performed. To date, after 18 months of follow-up, the patient is disease free with an adequate preservation of function.
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Sinovite Pigmentada Vilonodular/diagnóstico , Sinovite Pigmentada Vilonodular/terapia , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Terapia Combinada , Humanos , Imageamento por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Bucais , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.
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BACKGROUND: The authors overview the application of structural fat grafting (SFG) in the management of volumetric deficit in the maxillofacial area. Structural fat grafting was introduced as a way to improve facial aesthetics and in recent years has evolved into applications in craniomaxillofacial reconstructive surgery. METHODS: A retrospective cohort study population was composed of patients grafted with autologous fat referred to our department from February 2005 to July 2009. Each patient was operated on with SFG technique according to Coleman. Subjects were screened to these possessing an atrophy of facial soft tissues after trauma, tumor resection, congenital deformities and clefts, Parry-Romberg and scleroderma, orbital and periorbital surgery, facial palsy, burns, and scars. RESULTS: Forty-seven patients (27 females and 20 males) with a mean age of 38 years (minimum, 15 years; maximum, 71 years) were enrolled in the current study. The mean postoperative follow-up was 14 months. A total of 548 sites were grafted into 47 patients: malar, n = 103; nasolabial fold, n = 82; lip, n = 86; eyebrow, n = 32; jaw line, n = 18; philtrum, n = 19; forehead, n = 33; temple, n = 34; eyelid, n = 70; chin, n = 16; cheek, n = 25; nose, n = 23; and neck scar, n = 7. Each patient was operated on 1.6 times, and 11.6 was the average number of grafted sites. CONCLUSIONS: The authors have performed 548 procedures of SFG in 47 patients with good results as well as improvement in facial morphology, function, shape, and volume and improvement in the patients' appearance.
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Tecido Adiposo/transplante , Hemiatrofia Facial/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Idoso , Estética , Hemiatrofia Facial/etiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Transplante AutólogoRESUMO
Unilateral coronoid hyperplasia is a rare condition in the pediatric age. It may be an unrecognized cause of restricted mouth opening in children.The limited jaw movement is due to the enlargement of the coronoid process of the mandible that impinges on the zygomatic arch during mouth opening. This pathologic condition is still unknown and often misdiagnosed.Although in the past the term osteochondroma has been used to describe most of the unilateral and a few of the bilateral cases, there is no histologic evidence that the process has a neoplastic origin.Microscopic examination of the removed coronoid process has revealed hyperplastic compact bone covered with a thin layer of normal cartilage.There are multiple causes of mandibular hypomobility, each of them associated with different anatomic structures and etiologies, and a large number of cases, mostly bilateral, are idiopathic in nature.Several theories of pathogenesis have been proposed: temporomandibular joint dysfunctions, mandibular hypomobility, temporalis hyperactivity, hormonal stimulus, persistent cartilage growth center, genetic inheritance, and family factors.Unilateral coronoid hyperplasia is usually due to a trauma or a pathologic condition and is associated with facial asymmetry, being more frequently seen in women with histologic chondromatous or neoplastic changes. A thorough clinical history should include information about the onset and progression of pain and other subjective symptoms.In this study, we present a case of unilateral hyperplasia of the coronoid process in a 3 year-old female who, to the best of our knowledge, is the youngest patient so far reported with such anomaly.Our findings support the recommendation that early surgical treatment and aggressive postoperative physical therapy should be taken into account to allow for recovery of morphology and growth function in children.
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Assimetria Facial/cirurgia , Doenças Mandibulares/cirurgia , Pré-Escolar , Assimetria Facial/congênito , Assimetria Facial/diagnóstico por imagem , Feminino , Humanos , Hiperplasia/congênito , Hiperplasia/diagnóstico por imagem , Hiperplasia/cirurgia , Doenças Mandibulares/congênito , Doenças Mandibulares/diagnóstico por imagem , Modalidades de Fisioterapia , Radiografia , Resultado do TratamentoRESUMO
INTRODUCTION: Unilateral sinus disease (USD), and especially unilateral maxillary sinusitis (UMS), is an increasingly common finding in the ear, nose, and throat and maxillofacial practice. The aim of this retrospective study was to describe the clinical features of a series of patients affected by USD and, in particular, UMS due to sinonasal anatomic anomalies and of odontogenic origin. MATERIALS AND METHODS: A total of 292 patients affected by UMS were reviewed. Medical charts, radiological images, and surgical notes were all reviewed, particularly including data on UMS due to sinonasal anatomic anomalies and on UMS of odontogenic origin. RESULTS: A total of 66 patients have been excluded due to a diagnosis of malignant disease or other benign-defined etiology. Forty-eight patients (21.2%) affected by UMS due to sinonasal anatomic anomalies, whereas 178 (78.8%) patients affected by an odontogenic sinusitis. All patients were surgically treated by functional endoscopic sinus surgery, often in combination with a maxillofacial approach. DISCUSSION: UMS of odontogenic origin represented the greater group of USD. Computed tomography scans are always recommended to define UMS etiology (in particular excluding a malignant origin) and also to plan the most adequate surgical treatment.
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Fractures through the mandible at the level of the parasymphysis extending obliquely and traversing through the transitional zone to body region are relatively common. Therefore, a surgeon should have an appropriate understanding of the biomechanics of different plating techniques to fix these fractures. There is always a dilemma for the surgeon as to whether to fix these mandibular segments with one or two miniplates, and the presence of mental neurovascular bundle makes it more challenging. A study was planned in the Department of Oral and Maxillofacial Surgery to evaluate a novel twin-fork design of a miniplate used for fracture fixation at the transition zone of parasymphysis and body region of mandible after an in-vitro study of same design, and provided encouraging results. A total of 30 patients (10 patients in three groups each) were included in the study. All patients were evaluated preoperatively and postoperatively for operating time, ease of placement of miniplate, occlusion, reduction of fracture, neurosensory disturbances and infection. The novel design of twin-fork-shaped miniplate proved to be superior to the conventional miniplate in terms of neurosensory (Fisher exact test 17.40; p = 0.003) and functional outcome. There was statistically significant difference (χ2 = 13.895, p = 0.031) in postoperative reduction of fracture at week 4, indicating superiority of the twin-fork miniplate among the other conventional designs. The study concludes that the use of newly designed twin-fork-shaped miniplate should be encouraged in the fractures of transitional zone of parasymphysis-body region involving mental neurovascular bundle.
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Fraturas Mandibulares , Placas Ósseas , Oclusão Dentária , Fixação Interna de Fraturas , Humanos , Mandíbula , Fraturas Mandibulares/cirurgiaRESUMO
The mandibular parasymphysis and body regions are highly dynamic areas. They are constantly subjected to both occlusal and muscular forces. Fractures at this transition zone of the parasymphysis and body region thus represent a special pattern that creates a dilemma for the surgeons - whether to use one miniplate fixation or two miniplates as per Champy's guidelines. Mental nerve paresthesia is a very common complication due to dissection and stretching of the mental nerve in this region. Hence, an in-vitro research study of a novel twin fork design of miniplate is performed, which evaluates the biomechanical behavior using computerized finite element analysis. A comparison is carried out with the conventional design. The results show that the twin fork miniplate produces the lowest stresses - 23.821 MPa - and the least total structural deformation after applying the maximum occlusal bite force. This study concludes that the newly designed miniplate is superior in terms of stability because it shows the least structural deformation, and produces the lowest equivalent stresses on application of maximal occlusal forces. An additional advantage is the preservation of the mental nerve during the plating procedure because the broad end of the Y shape allows atraumatic positioning of the miniplate and hence the fixation of fractured segments.
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Fenômenos Biomecânicos , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Mandíbula/cirurgia , Fraturas Mandibulares/cirurgia , Força de Mordida , Placas Ósseas , Simulação por Computador , Análise do Estresse Dentário , Desenho de Equipamento , Fixação Interna de Fraturas/instrumentação , Humanos , Técnicas de Fixação da Arcada Osseodentária/instrumentação , Miniaturização , Estresse Mecânico , Titânio/químicaRESUMO
Pediatric orbital floor fractures exhibit distinctive features that distinguish them from orbital injuries seen in the adult population. This is mainly due to different anatomy and mechanical properties of the orbital bones in children. The management of pediatric orbital floor fractures requires consideration of these factors, including the age of the patient and therefore child's growth potential, using, if possible, a minimally invasive surgical approach. The aim of this paper is to report a case of a 1-year-old male child with a surgically treated blowout fracture of the orbital floor. To enable early diagnosis and treatment, accurate physical examination is mandatory, but a computed tomographic examination is important, especially in younger patients because of their inability to fully express their symptoms and poor compliance. We discuss the specific presentation and diagnostics of orbital floor fractures in early childhood and the related surgical planning and treatment.
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The aim of this study is to report a case series of blowout fractures of the medial orbital wall that were treated endoscopically. Isolated fractures of the medial orbital wall are uncommon and can be asymptomatic. Various surgical methods for repairing medial orbital wall fractures have been described. The standard approach for the treatment of medial orbital wall fractures is the transcutaneous approach or the transconjunctival with retrocaruncular approach. In the last years, the attention on the use of minimally invasive techniques such as transnasal endoscopic approach is growing. This was a retrospective study of six cases completely managed endoscopically. In the presented case series, the endoscopic endonasal approach represented a safe and effective procedure for the reduction of medial wall orbital fractures.
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BACKGROUND: Osteoma is a benign tumor composed of both cortical and cancellous bones that increase in size with continuous formation of bone. The pathogenesis is unknown. Osteomas can cause symptoms depending on their location and size. They can be asymptomatic or symptomatic, with trismus, limitation of mouth opening, and progressive malocclusion with facial asymmetry and can be painful. AIM: The aim of this paper is to report an unusual case of osteoma in the mandibular condylar neck and review the cases of mandibular condyle osteomas that have been reported in the last 15 years. CONCLUSIONS: Only a few cases involving the temporomandibular joint have been reported. We report an unusual case of osteoma in the mandibular condylar neck causing restricted mouth opening in addition to pain. Complete surgical excision in symptomatic cases is the therapy of choice with a low recurrence rate.
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Proboscis lateralis (PL) is a rare malformation, reported for the first time in 1861 by Forster in his monograph on congenital malformations of the human body. The abnormal side of the nose is represented by a tube-like rudimentary nasal structure, attached at any point along the embryonic fusion line between the anterior maxilla and the frontonasal processes. As clefts of the lip (and alveolus) are bilateral or unilateral, an arrhinia can be bilateral (total) or unilateral. In this case it is a 'hemi-arrhinia' (or heminasal agenesis. The arrhinias represent three groups of anomalies, each with different levels of clinical severity, some involving association with the labio-palatal cleft or agenesia of the premaxilla (1). In PL the nasal cavity on the affected side is replaced by a tubular appendage located off-center from the midline of the face, arising commonly from the medial aspect of the roof of the orbit (2). It is usually associated with heminasal aplasia or hypoplasia, microphthalmia, and - less commonly - with midline clefting. Associated brain and cranial vault anomalies are seen in 19% of these patients. PL is usually unilateral, with very few symmetrical/bilateral cases being reported (3). Morpho-aesthetic and psychological problems are frequent concerns for the patients and their families. In this study, the authors describe a clinical case and the chosen surgical technique, as well as reviewing the alternative techniques present in the literature.
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Doenças Nasais , Fissura Palatina , Anormalidades Congênitas , Estética Dentária , Humanos , Nariz/anormalidadesRESUMO
Mucoceles are benign, expansile cystic masses covered by respiratory epithelium filled with mucus secreted by goblet cells interspersed in the ciliated mucosa. Mucoceles result from the accumulation and retention of the products of secretion, desquamation, and inflammation in cases where the drainage is obstructed. We present a case of a nasal mucocele that developed in a 50-year-old man, possibly related to a craniofacial trauma that had occurred 24 years earlier. This is an unusual case of posttraumatic glabellar mucocele with subcutaneous extension and nasal bone erosion without any neurologic or ophthalmologic involvement.
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Fibrous dysplasia (FD) is a disturbance of the mesenchymal tissue that accounts for 2.5% of all bone tumors and more than 7% of nonmalignant bone tumors. In the craniomaxillofacial region, FD affects the calvaria, skull base, zygoma, and jaws, the prevalent site being the maxilla (50% of cases). Therapy for craniomaxillofacial FD is surgical. The goals of surgery are to prevent functional disorders and restore facial symmetry, volume, and contour. In this article, we present a case of a young female patient affected by right orbital-zygomatic-maxillary FD. She had developed facial asymmetry and malocclusion that were corrected using the Schuchardt-Kufner osteotomy technique.
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INTRODUCTION: Pierre Robin sequence (PRS) is characterized by microgenia and retrognathia. Cleft palate and glossoptosis are frequently associated with airway obstruction and difficulty in swallowing. Distraction osteogenesis with micro-distractors has recently been considered as a surgical option during the neonatal age. CASE PRESENTATION: A 6-week-old female with PRS underwent mandibular lengthening in neonatal age. Mandibular osteotomies were performed with the piezoelectric scalpel. DISCUSSION: Piezosurgery represents an innovative technique as it offers the maxillofacial surgeon the opportunity to make precise bone cuts without damaging the soft tissue, minimizing the invasiveness of the surgical procedure, and the opportunity of working in a field which is almost totally blood free. CONCLUSION: The use of a piezoelectric device to perform this kind of surgery provides clinical and surgical results which would be difficult with traditional instruments, not only for the patient's benefit but also for the surgeon's. Preservation of the original bony structure, especially of the cancellous bone, will benefit the bone healing process due to its high estrogenic potential.
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INTRODUCTION: Anophthalmia may be congenital or acquired. Congenital anophthalmia refers to any orbit that contains a severely hypoplastic eye at birth (microphthalmia), or a complete absence of the globe due to failure of optic vesicle formation. In both those cases the aim of surgery is to stimulate adequate orbital growth. Acquired anophthalmic orbit may be due to trauma or tumour. In acquired forms the goal is restoration of orbital volume with adequate replacement of orbital contents. PATIENTS AND METHODS: In this study 28 patients (6 cases of congenital and 22 of acquired anophthalmia), were treated between October 1997 and August 2002, by applying protocols that are based on data from the literature. RESULTS: In 19 cases there were satisfactory results. Complications such as implant dislocation (3 cases), residual asymmetry (2 cases), and eyelid retraction required revisional surgery (4 cases). CONCLUSIONS: The different strategies applied for reconstructing the missing structures of the orbit in the congenital forms have given satisfactory results related to the type and complexity of the deformity. In rehabilitating a patient with an acquired anophthalmic orbit it is essential to ensure that the patient has realistic expectations regarding a final prosthesis. Interaction of the various healthcare professionals is also essential to help the patient and so develop new prosthetic devices as well as innovative methods for socket reconstruction.
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Anoftalmia/cirurgia , Órbita/cirurgia , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Protocolos Clínicos , Enucleação Ocular/reabilitação , Traumatismos Oculares/cirurgia , Neoplasias Oculares/cirurgia , Doenças Palpebrais/etiologia , Feminino , Humanos , Masculino , Microftalmia/cirurgia , Pessoa de Meia-Idade , Órbita/crescimento & desenvolvimento , Implantes Orbitários/efeitos adversos , Satisfação do Paciente , Complicações Pós-Operatórias , Falha de Prótese , Reoperação , Resultado do TratamentoRESUMO
The use of adipose tissue transfer for correction of maxillofacial defects was reported for the first time at the end of the 19th century. Structural fat grafting (SFG) was introduced as a way to improve facial esthetics and in recent years has evolved into applications in craniomaxillofacial reconstructive surgery. Several techniques have been proposed for harvesting and grafting the fat. However, owing to the damage of many adipocytes during these maneuvers, the results have not been satisfactory and have required several fat injection procedures for small corrections. The author's (L.C.) overview the application of SFG in the management of volumetric deficit in the craniomaxillofacial in patients treated with a long-term follow-up.