Nonsurgical Reshaping of the Lower Jaw With Hyaluronic Acid Fillers: A Retrospective Case Series.

Introduction: Nonsurgical aesthetic treatments of the lower face are increasing in demand. In particular, they aim to restore facial youth following the changes due to progressive resorption of facial skeleton and atrophy of facial fat compartments which give the perception of a descent face. Objectives: The aim of this research is to describe the nonsurgical reshaping of the aged lower jaw by means of hyaluronic acid fillers. Methods: A retrospective analysis of data from adult female patients undergoing treatment with hyaluronic acid injections in the lower third of the face was performed. Injection techniques, relevant anatomy of the anatomical area and rheological properties of the fillers to be used are highlighted. Results: Thirty-six consecutive patients were enrolled (100% female; mean age: 45.7 years). A minimum of 4 up to 7 vials of hyaluronic acid filler was injected to achieve the desired results. The visual analogue scale was used to assess patient satisfaction. Thirty-two patients (88.8%) rated their appearance post-treatment with a satisfaction score ranging between 85% and 100%. A total absence of ecchymosis and/or swelling in the early postoperative days has been highlighted. There were no cases of infection, paresthesia, hematoma or necrosis. Conclusions: For those patients not willing to undergo surgery, the jawline remodelling with hyaluronic acid fillers seems to be a viable option for ameliorating the definition of the lower third of the face. Nonetheless, it is mandatory to perform multilayer injections using fillers with different rheological properties.

An Italian Online Survey Regarding the Use of Hyaluronidase in Previously Hyaluronic Acid-Injected Noses Looking for Surgical Rhinoplasty.

Background: Nonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and is considered a valid alternative to surgical rhinoplasty in selected patients. Objectives: The aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. Methods: Between April and May 2021, an online survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding the types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase, an additional information was collected. Results: In a range of time of 2 months (April and May 2021), a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was approximately 18%. The majority of respondents (61.5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinoplasty after a waiting time of 3 to 4 weeks. Conclusions: Either direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However, a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase before surgery is mandatory, recommended, or not.

Warthin tumor: a potential source of diagnostic error.

PURPOSE: Warthin tumor, also known as papillary cystadenoma lymphomatosum, is a fairly common tumor. It makes up 14% to 30% of parotid tumors. There has been much interest in this tumor because of its typical and intriguing morphologic features: the association of benign-looking lymphoid and epithelial components and its frequent occurrence in the intraparotid or periparotid lymph nodes. Moreover, multifocal and/or bilateral Warthin tumors have been reported, and malignant transformation of Warthin tumor and its association with other malignancies have been documented. Warthin tumor can sometimes be confused with other pathologic lesions because of symptoms and signs that accompany the disease, so it could be treated as other pathologic lesions. PATIENTS AND METHODS: We present 3 patients. The first one had a differentiated squamous cell carcinoma, no lymph node metastasis, and a Warthin tumor of the left parotid gland. The other 2 patients presented monoclonal gammopathy and a high tracer uptake in the left parotid gland by the 18F-fluorodeoxyglucose positron emission tomography/computed tomography total body. RESULTS AND CONCLUSIONS: The aim of this study was to evaluate the clinical and histopathologic features of 3 cases where clinical presentation of a Warthin tumor lies in the possible errors in diagnosis and decision making and not least in the management of the patient.

Oncocytic carcinoma of the accessory lobe of the parotid gland.

Oncocytic carcinoma is a rare tumor of the parotid gland. An additional case, characterized by an exceptional localization in the accessory lobe of the parotid gland, never reported to date in the literature, is described. The clinical and histologic difficulties in relationship to the diagnosis of a midcheek mass consisting of an unusual tumor are emphasized.