Masseteric nerve ultrasound identification for dynamic facial reanimation purposes.

BACKGROUND: the masseteric nerve is one of the main options to neurotize free muscle flaps in irreversible long-term facial paralysis. Several preoperative skin marking techniques for the masseteric nerve have been proposed to limit the surgical dissection area, shorten the surgical time, and enable a safer dissection. However, these have shown variability amongst them and cannot preoperatively visualize the nerve. Thus, we aim to design an observational study to validate a high-frequency ultrasound (HFUS) nerve identification technique. METHODS: a systematic HFUS examination was designed and performed to visualize the masseteric nerve in 64 hemifaces of healthy volunteers. One-third were randomly selected to undergo an additional HFUS-guided needle electrostimulation to validate the HFUS image. RESULTS: the masseteric nerve was identified by HFUS in 96,9% of hemifaces (95% CI 0.89 to >0.99) and showed almost perfect agreement with direct needle stimulation as calculated with Cohen's kappa coefficient; 0.95 (CI 0.85 to 1.00). It was found within the masseter muscle, in between the deeper muscle bellies, at 18,3 mm (SD ±2,2) from the skin. Only in 12,9% of cases (95 CI 0.06 to 0.24) its course became adjacent to the mandible periosteum. Other important features, such as disposition in relation to the parotid gland or whether the nerve was directly covered by a thick intramuscular aponeurosis, could be well observed by HFUS. CONCLUSIONS: HFUS enables masseteric nerve identification and can give the surgeon specific information on anatomical relations for each examined individual prior to surgery.

White adipose tissue-infiltrated CD11b+ myeloid cells are a source of S100A4, a new potential marker of hepatic damage.

CONTEXT: The endocrine and immunological properties of subcutaneous vs visceral adipose tissue (sWAT and vWAT, respectively) have turned a milestone in the study of metabolic diseases. The cytokine S100A4 is increased in obesity and has a role in adipose tissue dysfunction. However, the cellular source and its potential role in hepatic damage in obesity has not been elucidated. OBJECTIVE: We aim to study the regulation of S100A4 in immune cells present in sWAT and vWAT, as well as its potential role as a circulating marker of hepatic inflammation and steatosis. DESIGN: A cohort of 60 patients with obesity and distinct metabolic status was analyzed. CD11b+ myeloid cells and T cells were isolated from sWAT and vWAT by magnetic-activating cell sorting, and RNA was obtained. S100A4 gene expression was measured, and correlation analysis with clinical data was performed. Liver biopsies were obtained from 20 patients, and S100A4 circulating levels were measured to check the link with hepatic inflammation and steatosis. RESULTS: S100A4 gene expression was strongly upregulated in sWAT- vs vWAT-infiltrated CD11b+ cells, but this modulation was not observed in T cells. S100A4 mRNA levels from sWAT (and not from vWAT) CD11b+ cells positively correlated with glycemia, triglycerides, TNF-α gene expression and proliferation markers. Finally, circulating S100A4 directly correlated with liver steatosis and hepatic inflammatory markers. CONCLUSION: Our data suggest that sWAT-infiltrated CD11b+ cells could be a major source of S100A4 in obesity. Moreover, our correlations identify circulating S100A4 as a potential novel biomarker of hepatic damage and steatosis.

Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospective study comparing autologous fat and synthetic substances.

Lipodystrophy is one of the foremost concerns among the HIV-positive population, and is often associated with psychosocial disorders. We evaluated the clinical efficacy of facial infiltrations with autologous fat, polylactic acid, and polyacrylamide gel using clinical inspection and facial photographs (ordinal scale). Additionally, we assessed the safety of the infiltration techniques and determined changes in patient satisfaction, emotional status, and quality of life. Evaluations were made at 48- and 96-week follow-up visits. This paper presents the 48- week follow-up results. The current analysis includes 138 patients: 8, 25, and 105 in the fat, polylactic acid, and polyacrylamide gel groups, respectively. At baseline, almost 50% of the patients (67/138) presented grades 3 and 4 lipoatrophy, but at week 48 only 7.5% (7/93) remained in these advanced grades (no patients from the polyacrylamide group). A new round of infiltrations at week 48 was necessary in 35% (33/93) of patients (88%, 84%, and 8% in the fat, polylactic, and polyacrylamide groups, respectively). No serious adverse events were detected with any of the substances. Patient satisfaction and quality of life improved significantly in all three groups. Infiltrations with autologous fat, polylactic acid, or polyacrylamide gel appear to be an effective and safe alternative to repair facial lipoatrophy, at least up to 48 weeks, significantly improving patient quality of life. Similar results were observed for all degrees of severity and between genders. Polyacrylamide gel provided the longest lasting benefits.

Ten-Year Safety with Polyacrylamide Gel Used to Correct Facial Lipoatrophy in HIV-Infected Patients.

Long-term results (>5 years) for synthetic substances used to repair facial lipoatrophy have not been published. We performed a cross-sectional study to evaluate the 10-year safety of polyacrylamide hydrogel (Aquamid) among the 751 patients from our unit who received facial infiltrations at least 10 years ago. Epidemiological and clinical data such as complications and patient satisfaction were collected. We also identified those patients who presented a facial infection at any time after infiltration. A total of 104 patients had received Aquamid at least 10 years ago. Before infiltrations, 24.0%, 41.3%, and 34.7% presented very severe, severe, and moderate facial lipoatrophy, respectively. After a mean (SD) of 10.3 (0.5) years since the infiltrations, 19.2%, 47.7%, and 31.7% of patients reported moderate, mild, and no signs of facial lipoatrophy. The values reported by physicians for the same categories were 1.9%, 10.6%, and 87.5%. Indurations were detected in 6.7% of patients and nodules in 3.8%. Five patients (4.8%) had a local infection. A further 15 patients with a shorter follow-up (less than 10 years) presented local infections (overall incidence considering the 751 patients who received infiltrations of Aquamid, 2.7%); the product had to be withdrawn in three cases. The majority of patients were highly satisfied (74.8%) or satisfied (23.4%) with the cosmetic results; among patients with severe or very severe lipoatrophy at baseline, 31.4% were satisfied and 65.7% were highly satisfied. Infiltrations with polyacrylamide hydrogel (Aquamid) are a safe strategy for the treatment of facial lipoatrophy in the long term. The rate of severe complications was low, and patient satisfaction with the cosmetic results was high. However, facial infections may appear in the long term. Therefore, HIV-infected patients who received synthetic substances should be carefully monitored over time.

Four-year safety with polyacrylamide hydrogel to correct antiretroviral-related facial lipoatrophy.

Infiltrations with synthetic substances are effective strategies for repairing facial lipoatrophy. However, few data are available on long-term safety. We describe the safety of polyacrylamide hydrogel in 145 patients who received facial infiltrations with Aquamid from September 2002 to April 2004. Epidemiological, clinical (mainly complications), and psychological data (patient satisfaction) were collected. We also recorded all patients who presented with a local infection at any time after receiving an infiltration. Sixty-two percent of patients presented with severe facial lipoatrophy before infiltration. The cumulative volume of Aquamid injected was 5.5 ml (4-18) per patient. During a mean (SD) of 50.2 (4.3) months after infiltration, only one patient presented with a local infection. Small palpable, nonvisible nodules or indurations were the most frequent complications (19.3% and 6.2%, respectively). If we include the remaining patients from our center (n = 294) who also received Aquamid (although less than 4 years ago), a further three patients presented with a local infection (incidence of 0.9%). Most patients (88.9%) were "satisfied" or "very satisfied" with the results; patients with mild to moderate baseline facial lipoatrophy were more satisfied than those with severe lipoatrophy ("very satisfied": 92.7% versus 86.5%, respectively). Only 17.4% reported mild impairment of lipoatrophy and only 9.2% required new infiltrations; however, 76% would have preferred more infiltrations. The high patient satisfaction and the low number of severe complications after at least 4 years of facial infiltrations with Aquamid reflect the long-term safety of this product for the repair of facial lipoatrophy. However, prolonged follow-up of these patients is recommended to detect unexpected long-term adverse reactions.