Comparison of Clinical Results of Crescent-Shaped Expanded Polytetrafluoroethylene (e-PTFE) and Granulated Rib Cartilage for Filling The Nasal Base to correct Midface Depressions.

Objective: The center of the face plays an important role in the fullness of our facial contours, however, sunken center of the face is more common in Asians than in Europeans and Americans. Expanded polytetrafluoroethylene (PTFE) and rib cartilage are commonly used to fill the nasal base to improve the hollowing of the center of the face. This study aimed to compare the efficacy and safety of crescent-shaped expanded polytetrafluoroethylene (e-PTFE) with granulated rib cartilage for nasal base filling to treat midface depressions. Methods: Fifty-one patients with mild to moderate midface depression and normal occlusion admitted to our department from June 2017 to August 2020 were selected. Comprehensive rhinoplasty was performed, which included nasal base filling using crescentic e-PTFE or granulated rib cartilage. They are all women, with an average age of 27.4 years. The e-PTFE group (group A) had 27 cases, while the granulated rib cartilage group (group B) had 24. Changes in two face parameters, the wing ear line and facial convexity, were measured and recorded based on preoperative and postoperative photographs of the patients and using 3D imaging technology. Postoperative complications and satisfaction were assessed by questionnaires to compare the two surgical approaches' differences, advantages, and disadvantages. Results: Postoperative midface depression improved significantly in 51 patients. Most of the patients who underwent both procedures showed significant improvement in the wing ear line and facial convexity. The 3D imaging has also helped us to more objectively assess the changes in midface concavity. Some patients experienced acute discomfort, such as foreign body sensation and stiffness in the surgical area, for the first three months after nasal base filler surgery. Still, these symptoms resolved on their own within six months. Most patients (92.6% in group A and 91.6% in group B) felt that they had natural facial expressions and were satisfied with the filler results. Conclusion: The use of crescentic e-PTFE and granular rib cartilage to fill the nasal base is easy to operate and has a quick postoperative recovery, allowing for good postoperative results. However, after some of the granular rib cartilage filling treatments, the height of the nasal base was lowered, which may be connected to its limited structural support, ease of displacement, and resorption. Crescentic e-PTFE is superior to granular rib cartilage in terms of both morphology and mechanical support. The crescentic e-PTFE filling method provides rapid postoperative recovery and good shape maintenance, but local stiffness is more pronounced than in the granular rib cartilage group. This may help the plastic surgeon's choice of surgical procedure.

The Spatial Relationship Between Coronoid Process and Zygomatic Complex After Reduction Malarplasty.

BACKGROUND: Reduction malarplasty presents challenges in terms of postoperative complications, particularly limited mouth opening. Excessive inward displacement of the zygomatic complex can impinge on the coronoid process resulting in restricted mouth opening. This study aimed to assess the spatial relationship between the coronoid process and the zygomatic complex after reduction malarplasty. METHODS: A retrospective study was conducted, including consecutive patients underwent reduction malarplasty. Radiological measurements were performed before surgery and during the final follow-up, including the coronoid-condylar index, distance between the coronoid process and zygomatic complex, and thickness and density of the temporal and masseter muscles. Clinical and radiographic data were recorded and analyzed. RESULTS: A total of 159 female patients were included with an average age of 28.1 years and a mean follow-up of 6.7 months. The mean coronoid-condylar index was 1:1.4, ranging from 1:0.6 to 1:2.6. Following surgery, the distances between the coronoid process and the anterior zygoma decreased by approximately 1 mm. Additionally, the postoperative distance between the highest point of the coronoid process and the zygomatic arch decreased by around 4 mm horizontally and changed approximately 1 mm vertically. No significant changes were observed in the thickness and density of the temporal and masseter muscles after surgery. CONCLUSIONS: Reduction malarplasty led to a slight decrease in the distance between the coronoid process and the zygoma. The operation generally resulted in proximity between the highest point of the coronoid process and the zygomatic arch. However, we believe that common reduction malarplasty rarely leads to osseous impingement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Recent development and application of membrane chromatography.

Membrane chromatography is mainly used for the separation and purification of proteins and biological macromolecules in the downstream processing process, also applications in sewage disposal. Membrane chromatography is recognized as an effective alternative to column chromatography because it significantly improves chromatography from affinity, hydrophobicity, and ion exchange; the development status of membrane chromatography in membrane matrix and membrane equipment is thoroughly discussed, and the applications of protein capture and intermediate purification, virus, monoclonal antibody purification, water treatment, and others are summarized. This review will provide value for the exploration and potential application of membrane chromatography.

Photochromic Polyurethane Coatings with Cross-Linked Structure and Self-Healing Behavior Based on the FRET Effect.

Intelligent fluorescent coatings have received widespread attention in the encryption technique field such as anti-counterfeit, while the traditional fluorescent coatings are easy to be damaged by external force. In this study, the fluorescent and self-healing anti-counterfeit coatings are prepared after rational molecular design. Two polymers containing fluorescent groups, including polyurethane containing the anthracene (AN) side group and polyimide containing the naphthalenediimide (NDI) structure are synthesized to realize multiple color changes with fluorescence through simply blending. Due to the overlapping fluorescence spectra of the groups, enabling the fluorescence resonance energy transfer effect (FRET), the coating with different group ratios exhibits tunable fluorescence under the same excitation light, providing diverse patterns. Moreover, due to the reversible photo-crosslinking and thermal de-dimerization properties of anthracene, the recording, erasure, and rewriting of the surface pattern can be realized, and the fluorescent anti-counterfeit coatings exhibit excellent self-healing properties after cross-linking due to the FRET effect, which solves the problem of poor healing and ensures the stability and integrity. The fluorescent coating with cross-linked structure and self-healing behavior based on the FRET effect greatly expands the functional applications of traditional polyurethane materials.

Polyethylene glycol crosslinked decellularized single liver lobe scaffolds with vascular endothelial growth factor promotes angiogenesis in vivo.

BACKGROUND: Improving the mechanical properties and angiogenesis of acellular scaffolds before transplantation is an important challenge facing the development of acellular liver grafts. The present study aimed to evaluate the cytotoxicity and angiogenesis of polyethylene glycol (PEG) crosslinked decellularized single liver lobe scaffolds (DLSs), and establish its suitability as a graft for long-term liver tissue engineering. METHODS: Using mercaptoacrylate produced by the Michael addition reaction, DLSs were first modified using N-succinimidyl S-acetylthioacetate (SATA), followed by cross-linking with PEG as well as vascular endothelial growth factor (VEGF). The optimal concentration of agents and time of the individual steps were identified in this procedure through biomechanical testing and morphological analysis. Subsequently, human umbilical vein endothelial cells (HUVECs) were seeded on the PEG crosslinked scaffolds to detect the proliferation and viability of cells. The scaffolds were then transplanted into the subcutaneous tissue of Sprague-Dawley rats to evaluate angiogenesis. In addition, the average number of blood vessels was evaluated in the grafts with or without PEG at days 7, 14, and 21 after implantation. RESULTS: The PEG crosslinked DLS maintained their three-dimensional structure and were more translucent after decellularization than native DLS, which presented a denser and more porous network structure. The results for Young's modulus proved that the mechanical properties of 0.5 PEG crosslinked DLS were the best and close to that of native livers. The PEG-VEGF-DLS could better promote cell proliferation and differentiation of HUVECs compared with the groups without PEG cross-linking. Importantly, the average density of blood vessels was higher in the PEG-VEGF-DLS than that in other groups at days 7, 14, and 21 after implantation in vivo. CONCLUSIONS: The PEG crosslinked DLS with VEGF could improve the biomechanical properties of native DLS, and most importantly, their lack of cytotoxicity provides a new route to promote the proliferation of cells in vitro and angiogenesis in vivo in liver tissue engineering.

Nocardia albiluteola sp. nov., a novel lignin-degrading actinobacterium isolated from rhizosphere soil of pumpkin.

A novel lignin-degrading actinobacterium, designated NEAU-G5T, was isolated from pumpkin rhizosphere soil collected from field in Mudanjiang, Heilongjiang Province, northeast China, and characterized using polyphasic approach. The prior 16S rRNA gene sequence similarities and phylogenic analysis showed that strain NEAU-G5T exhibited close phylogenetic relatedness to Nocardia miyunensis NBRC 108239T (98.82 %), Nocardia nova NBRC 15556T (98.75 %), Nocardia jiangxiensis NBRC 101359T (98.68 %) and Nocardia macrotermitis RB20T (98.61 %). Morphological and chemotaxonomic characteristics indicated that strain NEAU-G5T could be assigned to the genus Nocardia. The polar lipids consisted of diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol, an unidentified phospholipid and an unidentified lipid. The predominant menaquinone was MK-8(H4, ω-cycl). The major fatty acids (>10 %) were identified as C16 : 0, C18 : 1 ω9c, 10-methyl C18 : 0 and C18 : 0. Mycolic acids were present. The genomic DNA G+C content of strain NEAU-G5T was 68 mol%. Moreover, based on digital DNA-DNA hybridization and average nucleotide identity values, strain NEAU-G5T could be differentiated from its reference strains. In addition, an azure B plate decolorization test and genomic analysis indicated that strain NEAU-G5T had the ability to degrade lignin. On the basis of polyphasic characteristics, strain NEAU-G5T represents a novel species of the genus Nocardia, with the name Nocardia albiluteola sp. nov. The type strain is NEAU-G5T (=CCTCC AA 2021018T=DSM 110547T).

Dynamic Covalent C═C Bond, Cross-Linked, Injectable, and Self-Healable Hydrogels via Knoevenagel Condensation.

Hydrogels have a wide range of applications in the fields of biomedicine, flexible electronics, and bionics. In this study, injectable and self-healable hydrogels were first prepared based on a dynamic covalent C═C bond formed via the Knoevenagel condensation reaction between poly(ethylene glycol) dicyanoacetate and water-soluble poly(vanillin acrylate). Three kinds of catalysts (phosphate buffer, zeolitic imidazolate framework-8, and tertiary amine) were used in Knoevenagel condensation for preparing hydrogels. All hydrogels in this study could be formed in situ, and their gelation time ranged from seconds to minutes. The properties and application of hydrogels could be customized according to the type of catalyst employed. 3-[4,5-Dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) results indicated that all the components and hydrogels exhibited low toxicity, and the hydrogels could be used as 3D cell culture scaffolds. Because of the dynamic covalent C═C bond formed by Knoevenagel condensation, the resultant hydrogels were found to be dynamic and showed good self-healing properties. This work presents a new dynamic covalent chemistry for the preparation of self-healable materials.

Organic Semiconductors for Photothermal Therapy and Photoacoustic Imaging.

In recent years, semiconducting polymer nanoparticles (SPNs) have been attracting considerable attention because of their outstanding characteristics such as higher light and thermal stability. They are widely used in fields of biomedicine such as photoacoustic (PA) imaging (PAI), photodynamic therapy (PDT), and photothermal therapy (PTT). PAI, a new imaging modality based on PA effects, shows great promise in biomedical applications. SPNs that display strong optical absorbance in the visible and near-infrared (NIR) regions can be promising candidates for in vivo PTT and PAI. Here we introduce the preparation of organic conjugated polymer fluorescent nanoparticles in the aqueous phase. We then discuss the application of water-dispersible conjugated polymer nanoparticles in PA and PTT. Finally, we discuss the opportunities and challenges for the development of organic conjugated polymer nanoparticles.

Conjugated-Polymer-Based Nanoparticles with Efficient NIR-II Fluorescent, Photoacoustic and Photothermal Performance.

Fluorescence imaging (FI) and photoacoustic imaging (PA) play important roles in the real-time assessment of cell-based therapies. However, the limitations of conventional organic fluorescence contrast agents and the narrow range of the emission wavelength in the first near-infrared (NIR-I) window (750-900 nm) hamper applications of fluorescence imaging in living subjects. Herein, we report the design and synthesis of a short-wave infrared FI contrast agent and PA contrast agent based on a conjugated polymer-poly{2,5-bis[(5-thiophen-2-yl)methylene]-3,6-bis(2-octyldodecyl)-2,5-dihydropyrazine}-and its use to construct multifunctional nanoparticles to simplify photothermal therapy.

Multifunctional Fe3O4@C-based nanoparticles coupling optical/MRI imaging and pH/photothermal controllable drug release as efficient anti-cancer drug delivery platforms.

Multifunctional nanomedicines featuring high drug loading capacity, controllable drug release and real-time self-monitoring are attracting increasing attention due to their potential to improve cancer therapeutic efficacy. Herein, a new kind of Fe3O4@C-based nanoparticles modified with isoreticular metal organic frameworks (IRMOF-3), folic acid (FA) and detachable polyethylene glycol (PEG) under tumor microenvironment was developed. The core-shell structured Fe3O4@C was synthesized via the one-pot solvothermal reaction and the IRMOF-3 layers were coated on the outer shell of Fe3O4@C through layer-by-layer coating method. The FA and PEG were conjugated on the surface of nanoparticles by reacting with the amine groups provided by IRMOF-3. The as-synthesized nanoparticles showed stable photothermal effect, superparamagnetic properties and blue fluorescence characteristic under 360 nm irradiation. The in vitro experiments showed that the drug loaded nanoparticles exhibit pH-dependent drug release property, and PEGylation was proved effective in suppressing burst drug release (only 8.0% of drugs were released within 95 h). The confocal laser scanning microscopy study revealed that the as-synthesized nanoparticles could serve as a cell imaging agent and the cell internalization can be significantly enhanced after FA modified. The IRMOF-3 modified nanoparticles showed negligible cytotoxicity and the drug loaded nanoparticles showed pH/photothermal-stimuli enhanced cytotoxicity in vitro. It is believed that the present smart drug delivery platforms will hold great potential in imaging guided drug delivery and cancer therapy.

Mandibular Augmentation With a New Sandwich Osteotomy: A Morphologic Study.

OBJECTIVE: Facial asymmetry is one of common complaints in plastic and craniofacial surgery in Orient. Hemimandibular dysplasia has considered to be the key role in facial asymmetry. Despite of the undergrow of mandibular length and height, the lackness of mandibular thickness contributes to the asymmetry. The aim of this study was to describe the therapeutic efficiency of mandibular augmentation with a new sandwich osteotomy with interpositional natural coral and coralline hydroxyapatite (CHA). METHODS: Nine goats were randomly divided into 3 groups and observed at 6, 12, and 18 months after surgery. All goats received splitting of bilateral mandibular outer cortex and interpositional grafting with natural coral and CHA, respectively (sandwich osteotomy). Data were evaluated and statistically analyzed by t-test. RESULTS: All goats were observed at 3 different time points. The computed tomography images show that the area of operation was healed and the thickness of the mandible was increased in 3 time points. In the 3 groups, mandibular thickness and volume were significantly different compared with those before operation (P < 0.05). The volume of CHA group improved better than coral group (P < 0.05). CONCLUSION: This study provides a promising alternative method for mandibular augmentation with a sandwich osteotomy and interpositional grafting with natural coral and CHA. The thickness and volume of mandible had been effectively increased in follow-ups.

Construction of Dimeric Drug-Loaded Polymeric Micelles with High Loading Efficiency for Cancer Therapy.

Polymeric micelles (PMs) have been applied widely to transport hydrophobic drugs to tumor sites for cancer treatment. However, the low load efficiency of the drug in the PMs significantly reduces the therapeutic efficiency. We report here that disulfide-linked camptothecin (CPT) as a kind of dimeric drug can be effectively embedded in the core of poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) (PCL-PEG-PCL) PMs for improving drug-loading efficiency, and PEG can be used as a hydrophilic shell. Moreover, the dimeric CPT-loaded PCL-PEG-PCL PMs exhibited excellent solubility in phosphate-buffered saline (PBS) media and significant cytotoxicity to cancer cells.

Interpositional Arthroplasty by Temporalis Fascia Flap and Galea Aponeurotica Combined With Distraction Osteogenesis: a Modified Method in Treatment of Adult Patients With Temporomandibular Joint Ankylosis and Mandibular Dysplasia.

BACKGROUND: Interpositional arthroplasty (IPA) with temporalis fascia flap has been one of the most frequently performed procedures to treat temporomandibular joint (TMJ) ankylosis. However, recurrence often occurs when the flap lacks bulk or atrophies. Whether to perform IPA or distraction osteogenesis (DO) first has long been a controversial issue when patients presented mandibular dysplasia (MD). This study provided IPA a new graft material sufficient to prevent recurrence, combined the modified protocol of performing DO 6 months after IPA, and evaluated its efficacy in treating TMJ ankylosis patients with MD. METHODS: Six patients with unilateral TMJ ankylosis and MD were treated in the authors' study. The temporalis fascia flap and part of adjacent galea aponeurotica were filled the space after surgical release. Mouth-opening exercises started immediately post-IPA. Distraction osteogenesis was performed 6 months after IPA and had a 4-month consolidation. The maximum interincisal distance at preoperative, immediately post-IPA and the latest follow-up were recorded, as was the distraction length. The body mass index was measured at each patient's postoperative visit. RESULT: All patients had significant improvements in facial aesthetic, mouth-opening, and occlusion. No major complication or recurrence was observed at 3 to 4 years' follow-up. The mean maximum interincisal distance was 4.83 ±â€Š2.79 mm preoperative and 35.67 ±â€Š3.39 mm at the latest follow-up. The mean distraction distance was 16.17 ±â€Š5.98 mm. The body mass index improved from 17.33 ±â€Š0.64 kg/m preoperative to 18.75 ±â€Š0.60 kg/m before DO. CONCLUSIONS: Temporalis fascia flap and adjacent galea aponeurotica as new graft materials are recommended for IPA. The modified staged treatment proved to be reliable and effective to prevent recurrence, improve mandibular length and final occlusion.

A covalent capillary coating of diazoresin and polyglycerol dendrimer for protein analysis using capillary electrophoresis.

Overcoming proteins adsorption on the inner surface of capillary has attracted increasing attention recently. By using the unique photochemistry reaction of diazoresin (DR), a new covalent capillary coating was prepared on the fused-silica capillary through layer-by-layer self-assembly of DR with polyglycerol (PG) dendrimer. The separation performance of covalently DR/PG-dendrimer coated capillary noticeably exceeded the bare capillary and the noncovalently linked DR/PG-dendrimer capillary. A baseline separation of lysozyme, myoglobin, bovine serum albumin, and ribonuclease A was achieved using CE within 20 min. Besides, the covalently linked DR/PG-dendrimer coating has the remarkable stability and reproducibility. Especially, compared with the traditional method which use highly toxic and moisture-sensitive silane coupling agent, this method seems to be a simple and environmental friendly way to prepare the covalently coated capillaries for CE.

Photosensitive diazotized poly(ethylene glycol) covalent capillary coatings for analysis of proteins by capillary electrophoresis.

A new method for the fabrication of covalently cross-linked capillary coatings of poly(ethylene glycol) (PEG) is described using diazotized PEG (diazo-PEG) as a new photosensitive coating agent. The film of diazo-PEG depends on ionic bonding and was first prepared on the inner surface of capillary by self-assembly, and ionic bonding was converted into covalent bonding after reaction of ultraviolet light with diazo groups through unique photochemical reaction. The covalently bonded coating impedance adsorption of protein on the central surface of capillary and hence the four proteins ribonuclease A, cytochrome c, bovine serum albumin, and lysosome can be baseline separated by using capillary electrophoresis (CE). The covalently cross-linked diazo-PEG capillary column coatings not only improved the CE separation performance for proteins compared to non-covalently cross-linked coatings or bare capillary but also showed a remarkable chemical solidity and repeatability. Because photosensitive diazo-PEG took the place of the highly noxious and silane moisture-sensitive coating reagents in the fabrication of covalent coating, this technique shows the advantage of being environment-friendly and having a high efficiency for CE to make the covalently bonded capillaries.

Prevalence of Brick Tea-Type Fluorosis in the Tibet Autonomous Region.

BACKGROUND: The prevalence of brick tea-type fluorosis is high in Tibet because of the habit of drinking brick tea in this region. Brick tea-type fluorosis has become an urgent public health problem in China. METHODS: A cross-sectional survey was conducted to investigate prevalence of brick tea-type fluorosis in all districts of Tibet using a stratified cluster sampling method. Dental fluorosis in children aged 8-12 years and clinical skeletal fluorosis in adults were diagnosed according to the national criteria. A total of 423 children and 1320 adults participated in the study. Samples of drinking water, brick tea, brick tea infusion (or buttered tea), and urine were collected and measured for fluoride concentrations by the fluoride ion selective electrode method. RESULTS: The fluoride level in all but one of the brick tea samples was above the national standard. The average daily fluoride intake from drinking brick tea in all seven districts in Tibet was much higher than the national standard. The prevalence of dental fluorosis was 33.57%, and the prevalence of clinical skeletal fluorosis was 46.06%. The average daily fluoride intake from drinking brick tea (r = 0.292, P < 0.05), urine fluoride concentrations in children (r = 0.134, P < 0.05), urine fluoride concentrations in adults (r = 0.162, P < 0.05), and altitude (r = 0.276, P < 0.05) were positively correlated with the prevalence of brick tea-type fluorosis. Herdsmen had the highest fluoride exposure and the most severe skeletal fluorosis. CONCLUSIONS: Brick tea-type fluorosis in Tibet is more serious than in other parts of China. The altitude and occupational factors are important risk factors for brick tea-type fluorosis.

Girdin/GIV is upregulated by cyclic tension, propagates mechanical signal transduction, and is required for the cellular proliferation and migration of MG-63 cells.

To explore how Girdin/GIV is regulated by cyclic tension and propagates downstream signals to affect cell proliferation and migration. Human osteoblast-like MG-63 cells were exposed to cyclic tension force at 4000 µstrain and 0.5 Hz for 6 h, produced by a four-point bending system. Cyclic tension force upregulated Girdin and Akt expression and phosphorylation in cultured MG-63 cells. Girdin and Akt each promoted the phosphorylation of the other under stimulated tension. In vitro MTT and transwell assays showed that Girdin and Akt are required for cell proliferation and migration during cellular quiescence. Moreover, STAT3 was determined to be essential for Girdin expression under stimulated tension force in the physiological condition, as well as for osteoblast proliferation and migration during quiescence. These findings suggest that the STAT3/Girdin/Akt pathway activates in osteoblasts in response to mechanical stimulation and may play a significant role in triggering osteoblast proliferation and migration during orthodontic treatment.

Inverse colloidal crystal membranes for hydrophobic interaction membrane chromatography.

Hydrophobic interaction membrane chromatography has gained interest due to its excellent performance in the purification of humanized monoclonal antibodies. The membrane material used in hydrophobic interaction membrane chromatography has typically been commercially available polyvinylidene fluoride. In this contribution, newly developed inverse colloidal crystal membranes that have uniform pores, high porosity and, therefore, high surface area for protein binding are used as hydrophobic interaction membrane chromatography membranes for humanized monoclonal antibody immunoglobulin G purification. The capacity of the inverse colloidal crystal membranes developed here is up to ten times greater than commercially available polyvinylidene fluoride membranes with a similar pore size. This work highlights the importance of developing uniform pore size high porosity membranes in order to maximize the capacity of hydrophobic interaction membrane chromatography.

Zygomatic Complex Change After Reduction Malarplasty and Its Geometric Model: A Retrospective Clinical Study.

PURPOSE: To achieve optimal outcomes in reduction malarplasty, the amount of removed zygomatic bone must be planned accurately. This study aimed to analyze the associations between the width of bony resection and changes in zygomatic bony parameters, to propose a geometric model to guide surgical planning, and to objectively evaluate the surgical outcomes of reduction malarplasty based on computed tomographic (CT) images. PATIENTS AND METHODS: This was a retrospective observational study of patients who underwent reduction malarplasty. Digitized CT images were used to evaluate the bony parameters of the zygomatic complex. A geometric model was proposed to guide surgical planning for malar reduction. The primary predictor variable was the width of the bony segment to be resected. The primary outcome variables were changes in malar prominence and attractiveness. Other variables included gender, age, and other bony parameters of the zygoma. Bivariate correlation analysis and multiple linear regression analyses were performed between predictor and outcome variables. Presurgical and postsurgical data were analyzed with paired-samples t test to evaluate surgical outcomes. Differences were considered statistically significant at a P value less than .05. RESULTS: Fifty-one patients who underwent reduction malarplasty with an L-shaped osteotomy from 2012 through 2014 were included in the study. Statistical analysis showed a significant decrease in malar prominence and increased attractiveness between presurgical and postsurgical images (P < .001). The width of bony resection was statistically associated with all outcome variables after adjusting for potential confounders. CONCLUSIONS: Reduction malarplasty with a modified L-shaped osteotomy resulted in a notable decrease in malar prominence and a statistical decrease in the zygomatic arch width. The amount of bone that must be removed from the zygoma to achieve a desired reduction can be calculated with geometric equations. The proposed methodology could assist surgical design and improve surgical accuracy.

Computer-assisted design of sequential surgical procedure for oblique facial clefts with mandibular outer cortex autografts.

BACKGROUND: Oblique facial clefts are congenital craniofacial malformations affecting the paramedian line of facial structures. Correction of these defects involves bone and soft tissue reconstruction. The authors have developed a computer-aided sequential surgical procedure for oblique facial clefts, including mandibular outer cortex autografting, medial canthal ligament reduction and fixation, and fat autografting. METHODS: From 2004 to 2013, 12 patients (9 women, 3 men) with oblique facial clefts were treated with the 3-step procedure in our clinic. Mean patient age at the first surgery was 18 years (range, 13-25 years). Preoperative three-dimensional surgical simulations assisted the surgeries. A retrospective review of patients' clinical, photographic, and radiographic records was performed. RESULTS: All patients achieved significant treatment effects and high satisfaction. The patients' self-assessed scores on a 10-point scale of deformity severity were lower after surgery (P < 0.001) and remained stable after 6 to 12 months (P = 0.069). Good repositioning of the inner canthus was achieved (P < 0.001) with no significant relapse (P = 0.096). The mean (SD) recovery of mandibular donor sites was 48.44% (16.89%) (range, 11.03%-71.33%). Grafted bone absorption was not significantly different at different recipient sites. Only minor complications occurred in 6 patients. CONCLUSIONS: This procedure was an effective treatment for oblique facial clefts, resulting in high satisfaction, remarkable improvements in facial symmetry, little skin scarring, acceptable bone graft resorption, and dramatic recovery of mandibular donor sites. Computer-assisted surgical simulation effectively describes characteristic skeletal deformities and provides a useful guide to surgical reconstruction.