Combined Surgical-Orthodontic Treatment of Patients With Severe Parry-Romberg Syndrome.

ABSTRACT: Parry-Romberg syndrome (PRS) refers to a relatively rare dysfunction disease that is characterized by chronic progressive maxillofacial atrophy, especially one side of facial skin, subcutaneous tissue, muscle, and bone. According to the atrophy degree of skin, subcutaneous tissue, and skeleton in the area innervated by the trigeminal nerve, PRS can be classified into mild, moderate, and severe. In general, cases with different severity have specific treatment regimens. For mild and moderate cases, soft tissue augmentation techniques are the optimal strategy for aesthetic reconstruction. In this study, the authors report a 19-year-old female with severe PRS. Considering the severity of the case, a combined surgical and orthodontic treatment was performed, which was involved in alveolar bone augmentation, preoperative and postoperative orthodontic treatment in combination with orthognathic surgery, medpor filling of zygomatic and maxillary complex, free fat grafting, as well as angulus oris and lip trimming. Comprehensive treatment is recommended for severe cases with extensive atrophy of soft tissue and craniofacial bone, obvious deviation of the chin and occlusal plane.

Aesthetic Restoration of Severe Hemifacial Atrophy With Free Adipofacial Antero Lateral Thigh Flap Followed by Autologous Fat Grafting; Optimizing Result and Long-Term Outcome.

BACKGROUND: Hemifacial atrophy (Romberg disease) is characterized by progressive soft tissue and bone atrophy on 1 side of the face. The process of atrophy usually starts in the late first or early second decade of life. Romberg Patients usually require soft tissue augmentation for the correction of their defect. There are many reconstructive tools available to correct such facial asymmetry. In this study, we evaluate the outcome of the free adipofacial flap followed by autologous fat grafting in the treatment of Romberg disease, regarding aesthetics and longevity of the treatment. PATIENTS AND METHODS: A retrospective review of 12 patients with moderate to severe hemifacial atrophy from April 2016 till March 2019. All patients received soft tissue augmentation with free adipofascial anterolateral thigh flaps, followed by autologous fat grafting 6 to 12 months later for correction of residual deformity. The average follow-up period was 18 months (range, 6-30). RESULTS: There were 9 females and 3 males in this study. All flaps were survived, and the effect is long-lasting during follow-up. Patients were satisfied with the result especially after refinement of the result of free tissue transfer. The donor sites were closed directly and with no apparent morbidities nor dysfunctions. CONCLUSIONS: Microsurgical free tissue transfer is considered a gold standard tool in the management of moderate and severe form of hemifacial atrophy. Among different flaps available, free adipofacial anterolateral thigh flap (ALT) works as a workhorse flap in the correction of a severe form of the disease. Autologous fat grafting is a versatile and reliable option to correct residual deformities. We believed that such a combination is a superb approach to optimize the outcome of the severe form of the progressive hemifacial atrophy.

[The feasibility of combined lipofilling methods in the treatment of patients with facial hemiatrophy]. / Vozmozhnosti primeneniia kombinirovannykh metodov lipofilinga pri lechenii patsientov s gemiatrofiei miagkikh tkanei litsa.

The basis of Central Research Institute of Dentistry and Maxillofacial Surgery in the period from 2015 to 2018 years there were 30 patients with primary hemiatrophy (group 1) and patients with hemiatrophy after reconstructive operations (group 2) who were examined and treated. The elimination of deformation of soft tissues was performed by combination of micro-, nano- and classical lipofilling in two sessions with an interval of 6 months. To determine the deficit of tissue volume on the affected side before and at the treatment stages, a computer tomography was performed with the construction of the mathematical surface of the face. A study of the nature of the changes in the underlying structures in each group was carried out using ultrasound scanning and LDF studies. The use of non-invasive research methods allows us to track the dynamics of skin transformation. Based on the results of the treatment in 2 groups, a combination of micro-, nano- and classical lipofilling did not only increase the volume and eliminate deformation soft tissue, but also transform the quality of the skin. Thus, the combination of various lipofilling methods allowed to achieve a more stable result and increase the efficiency of treatment.

Surgical Management of Progressive Hemifacial Atrophy With De-Epithelialized Profunda Artery Perforator Flap: A Case Report.

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by slow, unilateral atrophy of the soft tissues and bones of the craniofacial region. The defect becomes more pronounced with age, leading to esthetic and functional deficits. However, the proper timing and method of surgical reconstruction are still debated. The correction of this defect markedly influencing the quality of life of the patient can be achieved with less invasive to more invasive surgical approaches. A 21-year-old female patient with hemifacial atrophy and extensive alopecia presented to our clinic. Considering the body type and the expectations of the patient, a profunda artery perforator flap was applied for the reconstruction and esthetic improvement of the facial region. The facial asymmetry attenuated after the reconvalescence period. This case shows that in the up-to-date surgical treatment of severe PHA, the use of microvascular free flaps may provide a better approach when trying to achieve an acceptable esthetic result. This is the first time that a profunda artery perforator flap was used to restore facial asymmetry caused by PHA.

A Novel Method of Mild to Moderate Parry-Romberg Syndrome Reconstruction: Computer-Assisted Surgery With Mandibular Outer Cortex and Fat Grafting.

BACKGROUND: In patients with mild to moderate Parry-Romberg syndrome (PRS), plastic surgeons have mainly focused on the restoration of soft tissue deficiencies. While, bone deficits are easily overlooked. This study developed a new method combines the autologous mandibular outer cortex (MOC) grafting with fat grafting in mild to moderate patients with PRS, and apply computer-assisted techniques to improve the surgical outcomes and accuracy. METHODS: Seven patients with mild to moderate PRS were prospectively enrolled in the study. Preoperative and 7 days and 6 months postoperative computed tomography (CT) and photographs were performed. Computer-aided design was done based on preoperative CT data. Surgical templates for MOC harvesting and grafting were designed and printed out. The topographic map of fat grafting was generated. The accuracy of MOC bone grafting was evaluated by the MOC thickness relative error, the MOC thickness accuracy at the preop most severe bone atrophy point (preop MSBAP), and the MOC volume accuracy. The percentage volume maintenance of the fat grafting surgery was assessed. RESULTS: All 7 patients had ideal clinical outcomes with significant improvement in facial symmetry and no major complications happened. The average MOC thickness relative error is 2.85 ±â€Š0.50%. The average MOC thickness accuracy at the preop MSBAP is 3.36 ±â€Š1.13%. The average MOC volume accuracy is 3.41 ±â€Š1.37%. The average percentage volume maintenance of fat grafting is 62.79 ±â€Š5.73%. CONCLUSIONS: The combination of MOC grafting with fat grafting can be an excellent choice in reconstruction of mild to moderate patients with PRS. Applying computer-assisted techniques offers a reliable and accurate outcome.

Skeleton first in surgical treatment of facial disharmony.

PURPOSE: The aim of this study was to correct facial disharmony with or without occlusal dysfunction. METHODS: Based on computed tomography and presurgical design, restoration of normal skeleton relationship is a priority for selected facial deformities. Combination of different osteotomies for facial skeleton was chosen in 1-stage operation such as orthognathic surgery, zygomatic reduction, and mandibular angle reduction. Supplementary surgeries was considered in some cases as substitute implantation or autologous fat graft. RESULTS: All the 50 patients (hemifacial microsomia, Romberg syndrome, mandibular condyle hyperplasia, secondary cleft palate, and Crouzon syndrome) received surgeries, and their facial appearance improved significantly. Yearly follow-up shows that the symmetry and balance of the facial proportion approach normal, whereas most of their occlusal relationship has been significantly improved after the first stage of surgery. CONCLUSIONS: For most facial disharmony with or without occlusal dysfunction, skeleton-first surgery is a feasible strategy.

Treating Parry-Romberg Syndrome Using Three-Dimensional Scanning and Printing and the Anterolateral Thigh Dermal Adipofascial Flap.

BACKGROUND: As three-dimensional technology becomes more ubiquitous, many plastic surgical applications have emerged. The authors investigate a three-dimensional scanning and printing system for facial soft tissue reconstruction in conjunction with an anterolateral thigh dermal adipofascial flap for the treatment of Parry-Romberg syndrome. METHODS: Seven patients with facial atrophy of the zygomatic, buccal, and mandibular areas were included. Three-dimensional scanning of each patient's face in conjunction was analyzed with computer-aided design (CAD) to quantify areas of facial asymmetry. Models were then created using three-dimensional printing to map areas of soft tissue deficiency. Free anterolateral thigh (ALT) dermal adipofascial flaps were designed based on the three-dimensional models of soft tissue deficiency. RESULTS: All flaps survived. One case had a postoperative hematoma. Six patients had restored facial symmetry. One patient required fat injections to obtain symmetry. No patients required revision surgery of their healed flaps for contouring. CONCLUSIONS: Three-dimensional laser scanning and three-dimensional printing in combination with a free ALT dermal adipofascial flap offer surgeons a precise means to reconstruct facial contour deformities.

Total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and computer-aided designed and manufactured surgical splints: a favorable combination of three techniques in the management of severe mouth asymmetry in Parry-Romberg syndrome.

Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS.

Parry-Romberg reconstruction: optimal timing for hard and soft tissue procedures.

For the treatment of Parry-Romberg syndrome or progressive hemifacial atrophy, we studied 3 controversial issues: (1) optimal timing, (2) need for skeletal reconstruction, and (3) need for soft tissue (medial canthus/lacrimal duct) reconstruction. Patients with Parry-Romberg syndrome (>5 y follow-up) were divided into 2 groups: (1) younger than 14 years and (2) 14 years or older (n = 43). Sex, age, severity of deformity, number of procedures, operative times, and augmentation fat volumes were recorded. Physician and patient satisfaction surveys (5-point scale) were obtained, preoperative and postoperative three-dimensional computed tomographic scans were reviewed, and a digital three-dimensional photogrammetry system was used to determine volume retention. Our results indicate that the younger patient group required more procedures compared with the older patient group (4.3 versus 2.8); however, the younger group had higher patient/family satisfaction scores (3.8 versus 3.0). Skeletal and soft tissue reconstruction resulted in improved symmetry score (60% preoperatively to 93% final) and satisfaction scores (3.4 preoperatively to 3.8 final). Patients with Parry-Romberg syndrome required multiple corrective surgeries but showed improvements even when beginning before puberty. Soft and hard tissue reconstruction was beneficial.

Le Fort II osteotomy.

BACKGROUND: In comparison with the abundant literature on Le Fort I and III osteotomies, there is scant information on the Le Fort II osteotomy. Our goal in this study was to define the indications and techniques of the elective Le Fort II osteotomy. We reviewed our 30-year experience, which is the longest series of patients treated with Le Fort II osteotomies at a single institution. METHODS: A review of the records of 13 consecutive patients at our institution with a diagnosis of Le Fort II was conducted. Data analyzed included demographic information, indications, techniques, complications, and combined procedures. On the basis of surgical outcomes, a treatment algorithm was created. RESULTS: Thirteen patients had a diagnosis of Le Fort II at our institution. Five were excluded because of incomplete records or Le Fort II fracture repair. Three patients were male, and 5 were female. Their average age was 23 years, and the average follow-up was 60 months. Indications included nasomaxillary deviation related to unilateral coronal synostosis, hemifacial microsomia, Romberg disease, and noncleft nasomaxillary hypoplasia. The average estimated blood loss was 950 mL. Complications were persistent nasal deviation, temporary nasal obstruction, and a hematoma. Complementary procedures included bilateral sagittal split osteotomies, bone grafts, Le Fort I osteotomy, and repositioning of the zygoma. CONCLUSIONS: On the basis of this review, we have elucidated the indications and less invasive techniques of the elective Le Fort II osteotomy. No major complications were observed. A management algorithm for performing the Le Fort II osteotomy is presented.

Bilayer reconstruction for parry-romberg syndrome: using a free circumflex scapular artery-based adipofascial flap for both the buccal fat pad and subcutaneous fat.

PURPOSE: When using a free flap to reconstruct a facial deformity caused by Romberg's disease, it is important to prevent the flap from sagging after the operation. We report a new method of reconstructive surgery using a free subscapular adipofascial flap to prevent this problem. PATIENTS AND METHODS: Three female patients (ages 27, 28, and 34 years) with Parry-Romberg syndrome underwent microsurgical free scapular flap transfer for buccal defects. This operation requires making a gingivobuccal sulcus incision and forming a pocket for buccal fat reconstruction by dissecting over the periosteum of the maxillary bone. Preauricular and submandibular incisions are made to create a subcutaneous pocket for flap transfer. After the subscapular flap is elevated, we use its angiogram to observe its vascular pattern. The flap is separated to preserve the main blood vessels horizontal lower branches. The subcutaneous adipose tissue layer uses the horizontal branch, and the buccal fat pad layer the lower branch. METHODS: After the operations, the adipofascial flaps were in good condition and without postoperative complications. A half year after the first operation, revisional surgery was performed for one patient. No cases showed no sagging of the cheek, and in every case the overall appearance of the buccal region improved significantly. DISCUSSION AND CONCLUSION: Reconstruction of the buccal fat pad and subcutaneous adipose tissue using a free bilobed adipofascial flap nourished by the circumflex scapular artery, returned the adiposal tissue to its normal position, assuring more natural facial contours.

Use of various free flaps in progressive hemifacial atrophy.

OBJECTIVE: Romberg disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue, and bone. Facial asymmetry with soft tissue deficiency in Romberg disease causes a significant disability affecting the social life and can bring about many psychological problems. METHODS: The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, filler injections, cartilage and bone grafts, and pedicled and free flaps. We report our experiences with 11 patients involving 11 free flaps with a minimum 1-year follow-up. All patients were classified as having moderate to severe atrophy. The average age at disease onset was 4.5 years; the average duration of atrophy was 5.2 years. No patients were operated on with a quiescent interval of less than 1 year. The average age at operation was 20.1 years, ranging from 10 to 55 years. Reconstruction was performed using 4 groin dermofat free flaps, 4 latissimus dorsi muscle free flaps, and 3 other perforator flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le Fort I leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angle plasty, rib and calvarial bone graft, correction of alopecia, and additional fat graft. RESULTS: All patients were satisfied with the results. CONCLUSIONS: We believe that a free flap transfer is the requisite treatment modality for severe degree of facial asymmetry in Romberg disease.

Structural fat grafting: facial volumetric restoration in complex reconstructive surgery.

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.

Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome.

Parry-Romberg syndrome is an acquired facial deformity that manifests as progressive hemifacial atrophy that has unknown cause. Many surgical techniques to address it have been reported, such as fat transplantation and use of free flaps. Undoubtedly, the results of such techniques can be satisfactory for mild hemifacial atrophy after soft tissue restoration. But in severe cases, except for large-scale soft tissue atrophy, the osseous framework is involved, rendering their management difficult, and the results are often inadequate. On the basis of the severity of facial soft tissue atrophy and the extent of involvement of the osseous framework, we classified the deformities into 3 groups: (1) Mild: the facial atrophic area is confined to a small region and is located in the lateral face, the nasal ala and upper lip are normal, and there is no deviation of the oral commissure, and the occlusal plane is horizontal. (2) Moderate: there are large areas of soft tissue atrophy, and the nasal ala and upper lip are also affected; the oral commissure is deviated; the bony framework is nearly normal; and the occlusal plane is nearly horizontal or slightly deviated. (3) Severe: moderate form of soft tissue atrophy and serious bone framework atrophy, involving the zygoma, maxilla, and mandible; the chin and occlusal plane have deviated extensively to the affected side.In this article, we report our experience in successfully treating 23 patients with severe Parry-Romberg syndrome, according to our classification; mild and moderate cases were not included in this series. Microsurgical flap transplantation, lipoinjection, liposuction revision, dermis grafting, and cross-lip flap were used to correct soft tissue deformities, and bone augmentation using the MEDPOR implant, orthognathic surgery, bone grafting, and mandibular distraction were performed to reconstruct the bone framework.

Challenging Traditional Thinking: Early Free Tissue Transfer for Active Hemifacial Atrophy in Children.

BACKGROUND: Hemifacial atrophy (Parry-Romberg syndrome) is an enigmatic craniofacial disorder characterized by progressive facial atrophy. Early age at onset is associated with significant skeletal involvement and jaw abnormalities. Standard reconstructive dogma dictates that the disease should "burn out," with at least 2 years of no disease progression, before pursuing reconstructive intervention. The purpose of this article is to present the senior author's (J.W.S.) experience treating preadolescent children with free soft-tissue transfer for reconstruction of progressing hemifacial atrophy, and to review surgical techniques in this patient population. METHODS: Pediatric free tissue transfer cases performed by the senior author were reviewed. Free tissue transfer using a circumflex scapular adipofasciocutaneous flap was performed to treat deformities arising from hemifacial atrophy. RESULTS: Thirty-six patients aged 3 to 6 years underwent free tissue transfer in the presence of progressing, active disease. Follow-up ranged from 7 months to 25 years. There were no cases of flap loss. In all patients, the disease process seemed to be altered, with no symptoms recurring to date. CONCLUSIONS: The authors believe that early microsurgical correction of hemifacial atrophy in children as young as 3 years is reliable and effective. The authors theorize that the interposition of vascularized, healthy tissue may alter or even halt the progression of disease, and may also prevent the skeletal hypoplasia classically seen in older patients. Further study incorporating autologous fat grafting as a control procedure may provide additional insight into this challenging disease process. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Minimally invasive combined treatment for Parry-Romberg syndrome.

BACKGROUND: Facial hemiatrophy, a typical manifestation of Parry-Romberg syndrome, produces massive face asymmetry, causing marked aesthetic damage and severe psychological discomfort, with repercussions to the psychophysical status of the patient. This article presents a successful combined treatment that results in resolution of symptoms and patient satisfaction. METHODS: The authors proposed a clinic-therapeutic management comprising a customized program of bio-lipo-intense pulsed light (IPL) remodeling. RESULTS: In 2007, at a 1-year follow-up visit, the patient presented a stable result. She is satisfied with the augmentation treatment, the new volume and contours of the face, and the resolution of the sclerosis and ochrodermia. CONCLUSION: The authors have succeeded with a minimally invasive reconstructive technique for Romberg disease using a customized therapeutic program of poly-L-lactic acid, lipofilling, and IPL therapy. They report a case of good healing without recurrences and complications, with a good cosmetic result, and with satisfaction of the patient.

Parry Romberg Syndrome.

Parry-Romberg syndrome, or progressive hemifacial atrophy, is a rare disorder of unknown etiology. Patients present with unilateral atrophy of skin that may progress to involve underlying fat, muscle, and osseocartilaginous structures. Neurologic complications are common. After self-limited disease stabilization, various reconstructive options may be used to restore patients' facial symmetry. Serial autologous fat grafting has shown favorable results in reconstruction of mild or moderate soft tissue deficiency, but free tissue transfer remains the treatment of choice for severe disease.

Lipostructure technique in Romberg syndrome.

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the cause of this alteration are unknown. Pathogenesis of this syndrome is not clear: some authors refer the atrophy of subcutaneous system to the alteration of sympathetic system, whereas others refer it to an alteration of the nervous system referred to the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association to this health disorder are as follows: trigeminal neuritis, facial, and epilepsy, the last one being the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years, and soon after, it becomes stable. Today, plastic surgery with graft of autogenous fat can be performed after stabilization of the disease. The objective of this work is, through the presentation of a clinical case, suggesting a therapeutic plan formed by 2 sequential treatments: poliglactic acid to obtain skin thickening followed by Coleman technique for reconstructing three-dimensional projection of face contour restoring the superficial density of facial tissues. The results we obtained prove the efficacy of combining these 2 treatments, and the satisfaction of the patient confirms the quality of our results.

Use of diced bone grafts wrapped in surgicel in the augmentation of maxillofacial area.

The correction of asymmetry in craniomaxillofacial region presents many problems for reconstructive surgeons. For this purpose, varieties of different materials and techniques have been used. We present our experience with diced bone graft wrapped in Surgicel applied to 5 patients with facial atrophy due to various causes between the years 2005 and 2008. The average follow-up period was 18 months (range, 9-25 months). All bone grafts were diced into small pieces with a maximum size of 2 to 3 mm using a costotome. The smaller bone grafts were prepared according to the technique described by Erol (Plast Reconstr Surg. 2000;105:2229-2241) for cartilage grafts. Results of the patients' satisfaction were well. Wrapping bone grafts in Surgicel holds them together. Thus, it becomes easier to adapt the diced bone grafts to the area to be augmented. Molding of diced bone grafts wrapped in Surgicel in accordance with the three-dimensional structure of the face with gentle movements after adaptation is an important advantage, which classical bone grafts do not have. In the later periods, collagen-enhancing effect of Surgicel not only prevents the bone grafts' being noticed, but also softens its consistency. This in turn facilitates adaptation of bone grafts to the facial area.

Biomaterial implantation in facial esthetic diseases: ultrasonography monitor follow-up.

Facial deficit diseases are corrected by biomaterial implantation. The ideal biomaterial should be easy to implant and remove and simple to be identified by a low-dose radiation and low-cost radiologic technique. The purpose of this work was to evaluate ultrasonography (US) as a technique in monitoring biomaterial status after operation. In the last 3 years, for this study we used polyethylene porosus and polyacrylamide. Our study included 300 patients grouped accordingly as follows: malformative syndromes, degenerative syndromes, and esthetic problems, results of skull-facial traumas, and whether they are treated in the early phase and or the late phase. In this paper, we describe the better 15 clinical cases for their excellent result and for their variety of US images. Ultrasonography has been shown as an excellent way to visualize clinical features and a possible pathologic process of an implanted biomaterial; it is a noninvasive, low-radiation and low-cost dose radiologic technique. Reconstruction in facial deficit diseases needs adequate biomaterial to implant and a careful patients observation, that is, both clinical and radiologic. Ultrasonography is a fundamental component of the follow up of implanted biomaterial patients.