Customization of spectacle frames for individuals with facial deformities by altering conventional spectacle frames – Phase I

Purpose: Manufacturing a spectacle frame for a facially deformed individual is challenging because of facial asymmetry. One of the solutions is the customization of spectacle frames. Customization of spectacle frames for facially deformed individuals requires a better understanding of the facial anthropometry of deformed faces. This study aimed to analyze the facial anthropometry of deformed faces to understand the range of variability. The results of this study will be used to find customization methods in the future. Methods: We measured and analyzed the 12 facial parameters of individuals with facial deformities using the ImageJ software. Results: The data collected were normally distributed. Paired sample test revealed a statistically significant difference between innercanthus distances (right innercanthus distance [RICD] and left innercanthus distance [LICD]). Correlation analysis showed a positive difference between horizontal and vertical pupillary distance?innercanthus distance (PD?ICD) (0.68, 0.75, and 0.81) and pupillary distance?helix distance (PD?HD) (0.57, 0.68, and 0.59) relations. PD?ICD correlations are stronger compared to the PD?HD relation. Conclusion: Altering the frame center distance and the temple heights are the most important for asymmetric faces. Large population?based data are required to make concrete decisions to design a spectacle frame for asymmetric faces.

Evolución del concepto de deformidad facial / Evolution of the concept of facial deformity

RESUMEN Introducción: La cara es el soporte anatómico para el funcionamiento de los sentidos y piedra angular para la integración social. El paradigma biologicista se mantiene como base para la conceptualización teórica de las deformidades faciales, mientras el enfoque biopsicosocial de la salud, no se evidencia con fuerza para las deformidades faciales, se efectuó una revisión narrativa de la literatura, en las bases de datos: SciELO, PubMed, Redalyc e Infomed y con el buscador Google académico. Objetivo: Valorar los conceptos que se exponen en la literatura científica y proponer el más integrativo. Desarrollo: Se abordan fortalezas y limitaciones de 12 conceptos expuestos de acuerdo al enfoque de cada autor, dentro un contexto científico actualizado, además se valora cómo evoluciona el concepto desde el enfoque biologicista hasta el sociomédico, desde las primeras definiciones que no hacían referencia al impacto psicosocial de las deformidades o no eran inclusivas con toda la región facial, hasta las definiciones más integrativas a criterio de los autores y avalados por estudios de otros investigadores. Conclusiones: El concepto de deformidad facial ha evolucionado desde un paradigma biologicista a otro sociomédico. La extensión a toda la región facial, así como la percepción de los pacientes de sí mismos y de cómo la sociedad los asume e integra, debe ser parte del problema teórico a conceptualizar. Los autores proponen el concepto expuesto por Blanco y otros, por considerarlo el más integrativo; lo recomiendan para estudios de validación de contenido y su uso posterior en la práctica clínica.

ABSTRACT Introduction: The face is the anatomical support for the functioning of the senses and the cornerstone for social integration. The biological paradigm is maintained as the basis for the theoretical conceptualization of facial deformities, while the biopsychosocial approach to health is not strongly evidenced for facial deformities, a narrative review of the literature was carried out in the databases: SciELO , PubMed, Redalyc and Infomed and with the academic Google search engine. Objective: Assess the concepts that are exposed in the scientific literature and propose the most integrative. Development: Strengths and limitations of 12 exposed concepts are addressed according to the approach of each author, within an updated scientific context, as well as how the concept evolves from the biological to the sociomedical approach, from the first definitions that did not refer to the impact. psychosocial of the deformities or were not inclusive with the entire facial region, up to the most integrative definitions at the discretion of the authors and supported by studies by other researchers. Conclusions: The concept of facial deformity has evolved from a biological paradigm to a sociomedical one. The extension to the entire facial region, as well as the patients' perception of themselves and how society assumes and integrates them, must be part of the theoretical problem to be conceptualized. The authors propose the concept exposed by Blanco and others, considering it the most integrative; recommend it for content validation studies and subsequent use in clinical practice.

Nasal septum deviation and inferior nasal concha bone hypertrophy in class III facial deformity / Desviación del septum nasal e hipertrofia de la concha nasal inferior en deformidad facial clase III

SUMMARY: The aim of this research was to analyze the morphology of the nasal septum and inferior nasal concha bone in class III facial deformities prior to orthodontic treatment in orthognathic surgery candidates. 40 subjects were included in this research. The inclusion criteria were an Angle class III, negative overjet and SNA angle less than 80º. Patients with facial asymmetry, facial trauma or who had undergone maxillofacial or ENT procedures were excluded. CBCT images were obtained for all the patients and the nasal septum deviation, morphology of inferior nasal concha bone and ostium of the maxillary sinus were analyzed and related to the complexity of the facial deformity expressed by the ANB angle and dental relations. The measurement was standardized by ICC and the data was analyzed using a chi square test and Spearman's coefficient with a p value < 0.005 for statistical significance. Nasal septal deviation was observed in 77.5 %. The deviation angle was 13.28º (±4.68º) and the distance from the midline to the most deviated septum was 5.56 mm (±1.8 mm) with no statistical relation to the complexity of the facial deformity. The deviated nasal septum showed inferior nasal concha bone hypertrophy on the concave side of the nasal septum deviation (p=0.049). The open or closed condition of the maxillary sinus ostium was not related to any conditions in the septum or complexity of the facial deformity. Inferior nasal concha bone hypertrophy could be related to nasal septal deviation. The nasal condition in a class III facial deformity could not differ from the general population; careful in orthognathic surgery as to be assume in the Le Fort I Osteotomy and nasal approach related to nasal septum deviation and inferior nasal concha bone.

RESUMEN: El objetivo de esta investigación fue analizar la morfología del septum y la concha nasal inferior en sujetos con deformidad facial clase III previo al tratamiento de ortodoncia preparatorio para cirugía ortognática. Fueron incluidos 40 sujetos en esta investigación. Los criterios de inclusión fueron la de presentar una clase III de Angle, overjet negativo y ángulo SNA menor que 80º. Sujetos con asimetría facial, trauma facial o quienes presentaron algún tipo de procedimiento maxilofacial o de otorrinolaringología fueron excluidos. Tomografía computadorizada cone beam (CBCT) fueron obtenidas para todos los sujetos donde le morfología del septum nasal, morfología de la concha nasal inferior y el ostium del seno maxilar fueron analizados y relacionados con la complejidad de la deformidad facial expresada como ángulo ANB y relaciones dentales. Las medidas fueron estandarizadas por el ICC y los datos fueron analizados utilizando la prueba chi cuadrado y coeficiente de Spearman con un valor de p<0,05 para obtener relaciones significativas. La desviación del septum nasal se observó en el 77,5 %; el ángulo de desvío fue de 13,28º (±4,68º) y la distancia de desvío del septum desde la línea media fue de 5,56 mm (±1,8 mm) sin diferencias estadísticas en relación a la complejidad de la deformidad. El desvío de septum nasal demostró hipertrofia de la concha nsal inferior en el lado cóncavo del septum desviado (p=0,049). La condición de ostium abierto o cerrado no fue relacionado con ninguna condición del septum nasal o complejidad de la deformidad facial. La hipertrofia de la concha nasal inferior se relacionó con el desvío de septum nasal. La condición nasal en deformidad facial de clase III no es diferente de la observada en la población general; cuidados deben ser realizados en cirugía ortognática para el desarrollo de la osteotomía de Le Fort I y aproximación nasal en relación al desvío de septum y probable alteración de la concha nasal inferior.

Relación Transversal, Vertical y Sagital en Sujetos con Deformidad Facial Candidatos a Cirugía Ortognática / Transverse, Vertical and Sagittal Relationship in Subjects with Facial Deformity Candidates for Orthognathic Surgery

RESUMEN: El objetivo de este estudio fue evaluar la relación entre la clase esqueletal sagital y las condiciones transversales o verticales en sujetos con deformidad facial sin presencia de asimetría facial; Se realizó un análisis cefalomét rico de la clase esqueletal sagital, transversal y vertical en 115 sujetos con indicaciones de cirugía ortognática. Se consideró algunos datos del análisis cefalométrico de Steiner y el análisis cefalométrico de Ricketts en sentido sagital para determinar la clase esqueletal facial. A nivel transversal se determinó la dimensión transversal facial, dimensión transversal maxilar y dimensión transversal mandibular. A nivel vertical se determinó la dimensión vertical oclusal y dimensión vertical total. Al comparar las mediciones transversales y verticales entre sujetos de sexo femenino y masculino, se observó que los hom- bres presentaban mayores dimensiones que las mujeres (p=0,0001) en todos los análisis realizados. Los sujetos clase III presentaron mayor dimensión transversal facial (p=0,0002) y transversal mandibular (p=0,001) que los sujetos clase II. Además, se observó que los sujetos clase III presentaban mayor dimensión vertical total (p=0,002) que los sujetos clase II; Es posible concluir que existe características faciales transversales y verticales que se pueden relacionar con la posición sagital de las estructuras maxilo-mandibulares.

ABSTRACT: The aim of this study is to evaluate the relationship between sagittal skeletal class and transverse or vertical conditions in subjects with facial deformity without presence of facial asymmetry; A comparative study was conducted between the results of the cephalometric analysis of the sagittal, transverse and vertical skeletal class in 115 subjects with indications for orthognathic surgery. The Steiner cephalometric analysis in the sagittal direction was used to determine the facial skeletal class and the Ricketts cephalometric analysis in the sagittal analysis. At the transverse level it was determined the facial transverse dimension, maxillary transverse dimension and mandibular transverse dimension. At a vertical level it is determined the occlusal vertical dimension and total vertical dimension. When comparing cross-sectional and vertical measurements between female and male subjects, it was observed that male subjects presented greater dimensions than female subjects (p=0.0001). Class III subjects present greater facial transverse dimension (p=0.0002) and mandibular transverse dimension (p=0.001) than class II subjects. Also, it was observed that class III subjects had a greater total vertical dimension (p=0.002) than class II subjects; It is possible to conclude that there are facial characteristics transverse and vertical that can be related with the sagittal position of the maxillo-mandibular structures.

3-D airway analysis related to facial morphology / Análisis 3-D de la vía aerea relacionado con la morfología facial

The aim of this investigation was to define the volume and area of the airway in subjects with Class II and Class III skeletal deformity. A cross-sectional study was designed including subjects with facial deformity defined by Steiner's analysis in subjects with indication of orthognathic surgery who presented diagnosis by cone beam computerised tomography. We determined the measurements of maximum area, minimum area and volume of the airway. The data were compared using Spearman's test, with statistical significance defined as p<0.05. 115 subjects were included: 61.7 % Class II and 38.3 % Class III, mean age 27.8 years (± 11.6). A significant difference was observed in the area and volume measurements in the groups studied, with significantly smaller measurements found in Class II (p=0.034). The minimum area was 10.4 mm2 smaller in Class II patients than in Class III, while the general volume of the airway was 4.1 mm3 smaller in Class II than in Class III. We may conclude that Class II subjects present a smaller airway volume than Class III subjects.

El objetivo de esta investigación de definir el volumen y área de vía aérea en sujetos con deformidad esqueletal clase II y III. Se diseñó un estudio de corte transversal incluyendo sujetos con deformidad facial definida según análisis de Stainer en sujetos con indicación de cirugía ortognática que presentaran una tomografía computadorizada de haz cónico como elemento diagnóstico; en este examen se determinaron medidas de área mayor, menor de vía aérea y volumen presente; los datos fueron comparados utilizando pruebas estadísticas con el test de spearman considerando el valor de p<0,05 para definir significancia estadística. 115 sujetos fueron incluidos, siendo 61,7 % de tipo clase II y 38,3 % de sujetos clase III, con una edad promedio de 27,8 años (± 11,6). Se observó una diferencia significativa en mediciones de area y volumen en los grupos estudiados, siendo el grupo de clase II significativamente menor (p=0,034). El área de menor tamaño fue 10,4 mm2 en pacientes clase II que en pacientes clase III, mientras que el volumen general de la vía área fue 4,1 menor en los clase II que en los clase III. Es posible concluir que los sujetos de clase II presentan menor volumen de vía área que los sujetos clase III.

Lipotransferencia: una alternativa para el tratamiento de la deformidad facial adquirida / Lipotransfer: an alternative for the treatment of acquired facial deformity / A lipotransferência: uma alternativa para o tratamento da deformidade facial adquirida

RESUMEN Se presentó el caso de un paciente masculino de 58 años, con antecedentes de salud aparente, que refiere haber recibido tratamiento quirúrgico por fractura compleja de tercio medio facial (fracturas tipo Lefort II y malar III derecha), el mismo refiere inconformidad estética por la deformidad facial postraumática que presenta. Se decidió su ingreso en el Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García" para su tratamiento. Se diagnosticó deformidad postraumática secundaria a una fractura facial compleja y su consiguiente daño estético. Los resultados alcanzados con la utilización de la lipotransferencia de tejido graso abdominal para el tratamiento de la deformidad facial fueron satisfactorios con permanencia y estabilidad en un año, a la vez que cumplió con las expectativas del paciente. La lipotransferencia resulta una alternativa viable en el tratamiento de las deformidades faciales adquiridas.

ABSTRACT The case of a 58-year-old male patient was presented, with a history of apparent health, who reported having received surgical treatment for a complex fracture of the middle facial third (fractures Lefort II and right malar III), the same refers to aesthetic disagreement for the deformity posttraumatic facial presenting. It was decided to enter the Maxillofacial Surgery Service of the University Hospital "General Calixto García" for treatment. Posttraumatic deformity was diagnosed secondary to a complex facial fracture and its consequent aesthetic damage. The results achieved with the use of abdominal fatty tissue lipotransfer for the treatment of facial deformity were satisfactory with permanence and stability in one year, while meeting the patient's expectations. Lipotransfer is a viable alternative in the treatment of acquired facial deformities.

RESUMO Foi apresentado o caso de um paciente do sexo masculino, 58 anos, com histórico aparente de saúde, que relatou ter recebido tratamento cirúrgico para uma fratura complexa do terço facial médio (fraturas de Lefort II e malar III direita), o mesmo se refere a discordância estética quanto à deformidade apresentação facial pós-traumática. Foi decidido entrar no Serviço de Cirurgia Maxilofacial do Hospital Universitário "General Calixto García" para tratamento. A deformidade pós-traumática foi diagnosticada secundária a uma fratura facial complexa e seu conseqüente dano estético. Os resultados obtidos com o uso da lipotransferência de tecido adiposo abdominal para o tratamento da deformidade facial foram satisfatórios com permanência e estabilidade em um ano, atendendo às expectativas do paciente. A lipotransferência é uma alternativa viável no tratamento de deformidades faciais adquiridas.

Giant pleomorphic adenoma of submandibular salivary gland: a case report

The most common benign salivary gland tumor is the pleomorphic adenoma (PA). They can attain grotesque proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead to airway compromise. Authors report a case of a large PA arising from the right submandibular salivary gland in a 48-year-old male. The lesion measured 9cmx8cmx5cm.

Accuracy of three-dimensional camera system based on stereophotography on photographic acquisition of deformity facial images / 华西口腔医学杂志

OBJECTIVE@#To evaluate and analyze the accuracy of three-dimensional camera system acquisition based on stereophotography for the photographic acquisition of images of facial deformities.@*METHODS@#3D digital models of 45 waxen facial models of patients with facial deformities were obtained via a 3D camera system based on stereophotography. A total of 19 feature lines were measured on each 3D model by using the software. The measurements taken by the coordinate-measuring machine were accepted as standard values. Statistical analysis was performed to evaluate the accuracy of the system and the corresponding factors.@*RESULTS@#Statistical analysis results showed that the measured values of the characteristic distance obtained by 3D camera system were statistically different from the standard values (P0.05). The facial regions significantly influenced measuring error (P0.05). The middle facial regions had significant difference with bilateral facial regions on the percentage of measurement values (P0.05).@*CONCLUSIONS@#The accuracy of 3D camera system based on stereophotography for the photographic acquisition of facial deformities are influenced by the morphology of the facial deformities and facial regions. Moreover, the measuring error is acceptable in clinical settings.

Comparación entre las técnicas de Ricketts y Mcnamara para la determinación de la posición del maxilar y la mandíbula en jóvenes del Ecuador / Comparison between Ricketts and Mcnamara techniques for the determination of the maxilla and mandible position in Ecuadorian youths

RESUMEN: Los análisis cefalométricos, a partir de una radiografía lateral de cráneo, son amplios y variados considerando tanto los patrones funcionales como los de estética facial. Entre las técnicas de medición en cefalometría, Ricketts y de McNamara son ampliamente utilizados; ambas le entregan importancia a determinar la posición del maxilar y de la mandíbula con diferentes relaciones esqueletales. El objetivo de esta investigación es comparar ambas técnicas en una población joven de Ecuador; se realizó un análisis de concordancia utilizando el índice kappa de Cohen entre los resultados de las mediciones correspondientes a 44 radiografías cefálicas laterales de sujetos jóvenes entre 18 y 27 años de edad, de ambos sexos. En relación a la posición maxilar, el 56,82 % (IC 95 %: 42,18 % - 71,45 %) coinciden en el diagnóstico de protrusión maxilar; el índice de concordancia kappa de Cohen fue de 0,599 (IC 95 %: 0,354 - 0,854) con un valor p<0,05. En relación a la posición mandibular, el 50,0 % (IC 95 %: 35,23 % - 64,77 %) coinciden en el diagnóstico de retrusión mandibular; el índice kappa de Cohen fue de 0,460 (IC 95 % 0,229 - 0,691) con un valor p<0,05. Se concluye que, a pesar de manejar puntos de referencia cefalométricos diferentes, las dos técnicas de medición cráneo-facial son útiles para el estudio de posición de maxila y mandíbula. Existen diferencias entre algunos analisis de ambos estudios que pueden incidir en la selección terapéutica de potenciales pacientes.

SUMMARY: The cephalometric analyses from a lateral cranial radiograph, are wide and varied considering both functional and facial aesthetic patterns. Among the measurement techniques in cephalometry, Ricketts and McNamara are widely used; they both give importance to determine the position of the maxilla and mandible with different skeletal relationships. The objective of this research is to compare both techniques in a young population of Ecuador. A concordance analysis was performed using Cohen's kappa index between the results of the measurements corresponding to 44 lateral cephalic radiographs of young subjects between 18 and 27 years of age, of both sexes. In relation to the maxillary position, 56.82 % (95 % CI: 42.18 % - 71.45 %) coincide in the diagnosis of maxillary protrusion. Cohen's kappa concordance index was 0.599 (95 % CI: 0.354-0.854) with a p-value < 0.05. In relation to the mandibular position, 50.0 % (95% CI: 35.23 % 64.77 %) coincide in the diagnosis of mandibular retrusion. Cohen's kappa index was 0.460 (95 % CI 0.229 - 0.691) with a p-value < 0.05. It is concluded that, despite handling different cephalometric reference points, the two craniofacial measurement techniques are useful for the study of maxilla and mandible position. There are differences between some analyses of both studies that may affect the therapeutic selection of potential patients.

Nasal deformity in subjects with class III facial deformities / Deformidad nasal en sujetos con deformidad facial clase III

Dentofacial deformities present some shades and variations that determine the inclusion of different anatomical components as part of the disease; the aim of this study was to ascertain the nasal characteristics in patients with a Class III dentofacial deformity. A descriptive study was conducted on 20 patients diagnosed with a Class III facial deformity and a surgical indication; frontal and lateral as well as CT images were taken to analyze variables of nasal morphology and deformities associated with the nasal bridge, tip and septum. The results showed that the nasal angles are outside normal parameters and that the basal width of the nose is approximately 3 mm smaller than the intercanthal width; 45% of the subjects have lateral deviations, 50% bridge deformity and 80% septum deviation. It is concluded that there are nasal deformities in subjects with a Class III facial deformity and that this component must be carefully evaluated in the preoperative stage.

Las deformidades dentofaciales presentan algunos matices y variaciones que determinan la inclusión de diferentes componentes anatómicos dentro de la enfermedad; el objetivo de esta investigación es conocer las características de la nariz en pacientes con deformidad dentofacial de clase III. Se desarrollo un estudio descriptivo en 20 pacientes con diagnóstico de deformidad facial declase III e indicación quirúrgica; se estudiaron análisis fotográficos frontales y laterales así como tomografías computadorizadas para analizar variables de morfología nasal y deformidades asociadas al puente nasal, punta nasal y septo nasal. Los resultados demostraron que los ángulos nasales se encuentran fuera de los parámetros de normalidad y que el ancho basal de la nariz es aproximadamente 3 mm menor que el ancho intercantal; el 45% de los sujetos presentó desviación lateral, 50% deformidad del puente nasal y el 80% desvío de septo nasal. Se concluye que existen deformidades nasales en sujetos con deformidad facial de clase III y que este componente debe ser evaluado criteriosamente en la etapa preoperatoria.

Pharyngeal airway space in subjects with class II and class III facial deformities / Espacio de la vía aérea faríngea en sujetos con deformidad facial clase II y clase III

Facial deformities are related to morphological differences and the mandible position shows differences in maxillomandible relation. The aim of this research was to compare the pharyngeal airway space (PAS) in subjects with class II and class III facial deformities We included 28 adult subjects with skeletal characteristics associated to class II or class III according to the SNA angle and dental overjet; subjects with facial asymmetry and other facial deformities and subjects with facial trauma or facial surgery history were excluded. Cone beam computed tomography was realized (CBCT) to asses the nasopharynx, oropharynx, hypopharynx, as well as the distance measured between the mandible genial spine and hyoid bone; data analysis were realized by descriptive analysis and statistical analysis using t test with 0.05 to show statistical differences. Class II subjects presented minor values in all of the measurements; in the oropharynx and the hypopharynx we observed the most important differences, with nasopharynx showing statistically significant differences (p<0.05). In conclusion class II subjects presented a minor pharyngeal airway space and it is suggested that this information should be used in the diagnosis process and prior to surgical treatment.

Las deformidades faciales son asociadas a diferencias en la posición mandibular evidenciando diferencias en la relación maxilomandibular. El objetivo de esta investigación fue comparar el espacio aéreo faríngeo en sujetos con deformidad facial clase II y clase III. Se incluyeron 28 sujetos con características esqueletales asociadas a clase II o clase III seguidos de la evaluación del angulo SNA y el resalte dentario; se excluyeron los sujetos con asimetría facial y otras deformidades faciales y sujetos con historia de trauma facial o historia de cirugía facial; se realizó la tomografía computadorizada cone beam para evaluar el área de nasofaringe, orofaringe, hipofaringe y la distancia entre la espina geni mandibular y el hueso hioides; los datos se analizaron con estadística descriptiva y la prueba t usando un valor de 0,05 para establecer significancia estadística. Se observó que los sujetos de clase II presentaron valores menores a los sujetos clase III en todas las mediciones realizadas; en el área de orofaringe e hipofaringe se observaron las diferencias mas importantes, estadísticamente significativas (p<0,05). Se puede concluir que los sujetos con deformidad facial clase II presentan un espacio de vía aérea faríngea más estrecho y se sugiere que este temática sea resuelta en la etapa de diagnóstico previo a la selección de tratamientos quirúrgicos o no quirúrgicos.

Facial soft tissue in subjects with class II and class III facial deformities: preliminary results / Tejido blando facial en sujetos con deformidad facial clase II y clase III: resultados preliminares

Class II and class III skeletal anomalies require treatments that are both esthetic and functional, so the purpose of this investigation was to study the relationship between facial soft and hard tissues of patients with class II and class III deformities in the lower third of the face. A descriptive study was designed which included class II subjects with a SNB angle less than 78 and class III with a SNA angle less than 80. The soft tissue width was analyzed in relation to the Pg point, A point, B point, and upper and lower incisor cervical points. The naso-labial angle and interincisal angle were also analyzed. The studies were done using cone beam computerized tomography and analyzed with the software Simplant O&O (Materialise, Belgium). The results revealed similarities in the measurements of the facial width soft tissues with differences of less 1 mm in the Pg point, A point, B point, upper incisor point; the greatest differences were observed between the two groups in thelower incisor cervical point, with almost 5 mm difference in tissue size. The naso-labial angle also presented differences between the two groups, being more closed in the class III than in the class II subjects (approximate difference of 6). It can be concluded that there are minimal differences in the soft tissue width in class II and class III subjects; other parameters can be analyzed to search for differences that influence treatment planning and strategies for these patients.

Las anomalías esqueletales de clase II y clase III requieren tratamientos que asocian estética y función. El objetivo de esta investigación fue estudiar la relación entre tejidos blandos y duros faciales de pacientes con clase II y clase III facial, a nivel del tercio inferior facial. Se diseño un estudio descriptivo donde se incluyeron sujetos clase II con un ángulo SNB menor de 78 y clase III con un ángulo SNA menor de 80. Se analizó el ancho de tejidos blandos en relación a los putos Pg, punto A, punto B, y puntos cervicales de dientes incisivos maxilar y mandibular; también se analizaron los ángulos nasolabial e interincisivo; los estudios se realizaron en tomografía computadorizada cone beam y analizados en el software Simplant O&O (Materialise, Belgium). Los resultados demostraron semejanzas en las mediciones obtenidas en el ancho facial de tejidos blandos con diferencias menores a 1 mm en los puntos Pg, punto A, punto B y cervical incisivo maxilar; en relación al punto cervical del incisivo mandibular se observaron las mayores diferencias entre ambos grupos, cercanas a 5 mm de diferencia de tamaño en los tejidos; el ángulo nasolabial también presento diferencias entre ambos grupos, siendo en los sujetos clase III mas cerrado que en sujetos clase II (diferencia aproximada de 6). Se puede concluir que existen mínimas diferencias en el ancho de tejidos blandos en sujetos de clase II y clase III; otros parámetros pueden ser analizados para búsqueda de diferencias que influyan en planificaciones y estrategias terapéuticas para estos sujetos.

Analysis of the condyle, articular fossa and mandibular ramus in subjects with active condylar hyperplasia / Análisis del cóndilo, fosa articular y rama mandibular de sujetos con hiperplasia condilar activa

Facial asymmetry is relatively common, but it becomes a disease when condylar hyperplasia is involved. The purpose of this investigation was to describe and compare the morphological characteristics of hyperplastic condyles to their non-hyperplastic contralateral side. Fifteen subjects aged between 14 and 29 years with facial asymmetry and diagnosed with unilateral condylar hyperplasia were studied using cone-beam computerized tomography. Linear measurements were taken of the condylar morphology on the sagittal and coronal planes, establishing the size of the articular fossa, mandibular ramus, and other aspects. Sagittal condylar measurements showed significant differences (p=0.028) between the groups (hyperplastic side v/s non-hyperplastic side); ramus measurements showed significant differences (p=0.034) between the two sides. No significant differences were observed (p=0.155) in the relation of the mean lateral distance (coronal image) of hyperplastic and non-hyperplastic condyles. It can be concluded that there is an increase in the size of the hemimandible and TMJ on the hyperplastic side, although research with a greater number of patients is needed to establish a more precise trend.

La asimetría facial es relativamente común, transformándose en enfermedad cuando se asocia hiperplásia condilar. El objetivo de esta investigación fue describir y comparar las características morfológicas de los cóndilos hiperplásico con su contralateral no hiperplásico. Quince sujetos de entre 14 y 29 años de edad, con asimetría facial e hiperplasia condilar unliateral diagnosticada, fueron estudiados mediante tomografía computarizada Cone-Beam. Se determinaron mediciones lineales de la morfología condilar en vista coronal y sagital, estableciendo tamaños de la fosa articular, rama mandibular, entre otras. Las mediciones condilares sagitales mostraron diferencias significativas (p=0,028) entre los grupos (lado hiperplásico vs. lado no hiperplásico); las mediciones de longitud de rama mostraron diferencias significativas (p=0,034) entre ambos lados. No se observó diferencias significativas (p=0,155) en la relación de distancia medio lateral (imagen coronal) de cóndilos hiperplásico y no hiperplásicos. Concluimos que existe un aumento del tamaño hemimandibular y de la ATM del lado hiperplásico, aunque investigaciones con mayor número de pacientes son necesarios para establecer una tendencia mas exacta.

Estructura nasal en pacientes con deformidad facial clase III / Structure of the nose in patients with class III facial deformities

El objetivo de esta investigación fue conocer aspectos morfológicos de la estructura nasal en sujetos con diagnóstico de deformidad facial clase III. Se realizó un estudio con tomografía computadorizada Cone Beam sobre 20 pacientes entre 18 y 35 años para identificar mediciones a nivel de la apertura piriforme, huesos propios de la nariz y ángulos de dorso nasal y labio superior. El estudio se realizó en el software del sistema realizando las mediciones de acuerdo a condicione estándar; el análisis de datos fue de forma descriptiva y mediante la prueba t de student considerando el valor de p<0,05 para obtener significancia estadística. Los resultados demostraron importantes variaciones en la altura de los huesos nasales y la forma de la apertura piriforme; las mediciones mostraron algunas variaciones donde el ángulo nasolabial fue el que presentó valores bajo los 104, considerados fuera de la normalidad; no se presentaron relaciones significativa en ninguna de las evaluaciones realizadas en esta muestra. Se puede concluir que existen importantes variaciones anatómicas y que nuevas mediciones deben ser evaluadas para utilizarlas en métodos de diagnóstico y tratamiento.

The aim of this study was to obtain information on some morphological aspects of the nose structure in subjects with class III facial deformities. A study was carried out by computed cone beam tomography in 20 patients between 18 and 35 years of age to measure pyriform aperture, nasal bones, dorsal nasal angle and superior lip angle; the study was realized on system software, measurement was realized in standardized conditions and the data analyzed was descriptive and with student ´t´ test considering p<0.05 for statistical significance. The results showed high variations in nasal bones height and pyriform aperture shape; measurement showed some variations with nasal-lip angle with values less than 104o, considered outside of the normality. In some of the measurements, anatomical variations of the nose in these subjects was clear; there were no significant statistical differences in any of the measurements in this sample. It was concluded that there are important variations in the anatomical form and new measurements should be evaluated for their use in diagnosis and treatment.

Relación entre el tamaño condilar y la asimetría facial transversal en individuos con hiperplasia condilar / Relationship between condylar size and transverse facial asymmetry in subject with condylar hyperplasia

La asimetría facial es una patología de compromiso funcional y estético que puede estar generado por hiperplasia condilar; el objetivo de esta investigación es determinar la influencia del tamaño condilar en la asimetría facial. Doce sujetos fueron estudiados mediante el análisis de tomografía computadorizada cone beam; todos los pacientes presentaron cintigrama óseo que determino la presencia de hiperplasia condilar activa; el análisis se realizo en un software del sistema de captura modelo Pax Zenith, marca Vatech (Korea 2011), utilizando 90 kV y 120 mA; se obtuvo mediciones de la distancia antero-posterior, superior-inferior y medio-lateral de la cabeza del cóndilo, relacionándose con la posición del cóndilo con la línea mediana facial y la posición de puntos faciales entre incisivos centrales superior e inferior así como con el mentón. Los resultados mostraron un promedio de desvío de mentón de 6,5 mm considerando un cóndilo hiperplásico con un tamaño de 2,7 mm mas que los cóndilos normales. El desvío de incisivo central inferior determinó que por cada 1 mm de desvío dentario existe 2,2 mm de desvío de mentón. El cóndilo hiperplásico fue de mayor tamaño y se posiciono casi 2 mm mas hacia lateral que los cóndilos no hiperplásicos. Es posible concluir que el cóndilo hiperplásico presenta clara influencia en la asimetría facial transversa y es posible estimar una relación de tamaño condilar con grado de asimetría facial.

Facial asymmetry is a functional and esthetic pathology that can be related to condylar hyperplasia; the aim of this research was to asses the condylar size in the facial asymmetry. Twelve subjects was studies with cone beam computed tomography; the analysis was realized in the software Pax Zenith, Vatech (Korea 2011), using 90 kV and 120 mA and was realized anterior-posterior measurement, superior and inferior measurement and medial-lateral measurement of condylar head and was realized the relations with condylar position with the medial facial line and the position of facial point between superior central incisior, inferior central incisior and chin. The results show that the chin was displaced 6.5 mm from middle line being a hyperplasic condyle with a 2.7 mm more than no hyperplasic condyle. 1 mm of displacement of low central incisor was associated to 2.2 mm of chin displacement. The hyperplasic condyle presented more size and was posicionated 2 mm more lateral than non-hyperplasic condyle. Is conclude that the hyperplasic condyle present a clear influence in the facial transversal asymmetry and in possible to establish a relation between the size of hyperplasic condyle and the facial asymmetry.

Deformidad facial asimétrica: papel de la hiperplasia condilar / Asymmetric facial deformity: role of condylar hyperplasia

Las deformidades dentofaciales (DDF) son conocidas y su diagnostico es cada vez mas frecuente; las DDF asimétricas son un grupo de enfermedades de complejo manejo debido a las condicionantes estéticas y funcionales comprometidas. La etiología es variada, aunque la hiperplasia condilar suele estar asociada en los pacientes adolescentes y adultos; su diagnostico se establece mediante análisis facial, estudio con medicina nuclear, tomografías computadorizadas y otros exámenes. La terapéutica mas aceptada hoy día consiste en la condilectomia parcial y la corrección de la deformidad facial basada en las necesidades estéticas y funcionales del paciente. El objetivo de esta revisión es determinar las condicionantes actuales asociadas al diagnostico y tratamiento de las DDF asimétricas y el papel que cumple la hiperplasia condilar en el desarrollo de estas alteraciones faciales...

Dentofacial deformities (DDF) are know and the diagnosis is ever more executed; the asymmetric DDF are a group of disease with difficult management because of esthetic a functional conditions. The etiology is these conditions is varied, although the condylar hyperplasia is frequently in adolescent and adult patients; the diagnosis is realized by facial analysis, nuclear medicine study and computed tomography and others. The more accepted therapy is related to partial condilectomy and facial deformity correction in relation to aesthetic and functional needs of patient. The aim of this review is to determine the current conditions associated to diagnosis and treatment of asymmetric DDF and the role of condylar hyperplasia in the development of these facial alterations...

Treatment of Posttraumatic Facial Deformity Patient with Brown's Syndrome: Case Report

PURPOSE: Brown's syndrome is characterized by the limited elevation in adduction from mechanical causes around the superior oblique tendon trochlea complex. In this particular case, post-traumatic facial deformity accompanied by Brown's syndrome was observed. We would like to report the satisfying cosmetic results obtained by reconstructing orbital roof and superior orbital rim and repositioning of zygoma. METHODS: A 12-year-old patient was observed with facial deformity with strabismus in her right eye and orbital dystopia after the car accident and was eventually diagnosed with traumatic Brown's syndrome. Reconstructive surgeries could not be performed at the time of trauma due to the cerebral hemorrhage. At the second year after the trauma, a depressed fracture of the right orbital roof and superior orbital rim were reconstructed via the intracranial approach, and orbital dystopia was corrected via the zygoma triple ostectomy. In addition, a strabismus surgery was performed one year after her plastic surgery. RESULTS: Facial deformity with orbital dystopia and strabismus was confirmed to be fully reconstructed after the surgery. Moreover, when the patient came in for a follow-up thirteen years after the operation, a developmental imbalance of the facial bones, diplopia, or any other surgical complications were not to be found. CONCLUSION: After the trauma, the patient with Brown's Syndrome accompanied by post-traumatic facial deformity, who went under the corrective surgeries after the meticulous examination and assessment pre-surgically, was able to acquire cosmetic satisfaction via those operations.

Reconstruction of the Acquired Facial Deformity due to Cancrum Oris Sequelae

Acquired facial deformities following cancrum oris sequelae manifested variably according to the nature of tissue necrosis. In cases that tissue loss extends over a wide area of the face, or the tissue nature is different due to congenital facial cleft, it is difficult to reconstruct with a single operation. As cancrum oris has virtually disappeared from our country, clinical report of reconstruction is also rare. We report 5 cases of facial deformities following cancrum oris sequelae. Since 1988, five adult patients(4 female and 1 male) were treated by authors. These patients, with an age ranged from 47 to 58 years, all suffered from acquired facial cleft such as facial mutilation, asymmetry. The stages of operation were from 1 to maximum of 5 operations. All surgeries achieved satisfactory results after a long-term follow-up. But one surgery in the case of palatal mucosal flap for the coverage of reconstructed maxilla alveolar bone resulted tissue sloughness, followed by osteomyelitis. Those were debrided and discarded. In conclusion, all sites of deformities were positioned around one of the oral commissures. In their past medical history, they have been suffering from measles, typhoid fever and unknown febrile illness. We diagnosed the acquired facial deformity following cancrum oris sequelae. The reconstruction of acquired facial deformity following cancrum oris sequelae were difficult due to extensive multiple tissue defects. Therefore multiple staged operations were inevitable. The authors reconstructed 5 cases of simple and complex form of facial deformity with minimum staged\ operations. All patients were satisfied functionally and cosmetically.

A Case of Psammomatoid Ossifying Fibroma of Sinonasal Tract Presenting with a Facial Deformity and Choanal Atresia / 대한이비인후과학회지

The psammomatoid ossifying fibroma consisted of numerous cellular fibrous stroma, various bony trabeculae and calcified spherules (psammoma bodies) is known to typically involve the sinonasal tract. It is more destructive than the other benign fibroosseous lesions. Clinical manifestations vary from proptosis, nasal obstruction and headache to cosmetic disfigurement, depending on the location and the size of lesion. Complete surgical excision is the treatment of choice because of its tendency to recur. The author recently experienced a psammomatoid ossifying fibroma of sinonasal tract in a 37-year-old male with a facial deformity and choanal atresia, had a history of incomplete surgical excision. The choanal atresia was completely removed by endoscopic approach and the mass in the sinonasal tract was removed by midfacial degloving approach. We report this case with review of the literature.

Complex osteotomy for the correction of post-traumatic midfacial deformity

The traffic accident was one of most common cause for the facial bone fracture. When it involved the midfacial structures, the nasal bone fracture was usually shown. If the reduction was not done in time, it would result in facial deformity. Simple case could be corrected by simple rhinoplasty. However, severe cases would require more invasive technique. We used triangular osteotomy included the nasal bones, the vomer, and the medial wall of maxilla for the correction of post-traumatic nasal deformity and reported the result with the review of literatures.