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1.
Plast Reconstr Surg ; 2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32590515

RESUMEN

BACKGROUND: Facial asymmetry due to unilateral condylar hyperplasia (UCH) requires treatment to address facial and occlusal imbalances. There is no definitive evidence to suggest that a single intervention strategy (during either active condylar overgrowth or the burnt-out phase) results in better / more symmetric correction. This study sought to quantify pre- and post-operative facial asymmetry in UCH patients comparing treatment for active versus burnt out disease. METHODS: Pre- and post-operative three-dimensional (3D) photographs were obtained. Images were compared to unaffected controls as a standard for normal facial symmetry. Facial asymmetry was assessed using root mean squared deviation (RMSD). Paired student's t-tests were performed to compare the RMSDs of pre- and post-operative images between the UCH groups and against controls. RESULTS: Forty patients were included (11 active, 9 burnt-out, and 20 controls) and 60 3D images were evaluated. Pre-operatively, patients in the burnt-out group had worse asymmetry than those with active UCH (p = 0.011). Both groups demonstrated significantly improved symmetry post-operatively (active; p = 0.0069 and burnt out; p = 1.74E-4). However, burnt out patients remained with some residual asymmetry (p = 4.75E-4), while their active counterparts showed no significant difference compared to unaffected controls (p = 0.089). CONCLUSION: Patients with end-stage UCH have more severe facial asymmetry that is more difficult to normalize, compared to earlier intervention during active UCH. These findings suggest that, if possible, corrective intervention is preferable during active UCH.

3.
Oral Maxillofac Surg Clin North Am ; 32(2): 297-307, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32151372

RESUMEN

Orthodontic treatment of patients with unilateral and bilateral cleft palate requires an extensive interdisciplinary approach to achieve optimal functional and esthetic rehabilitation. Intervention is divided into 3 main stages: early mixed, late mixed, and permanent dentition. Treatment modalities can vary according to developmental stage, severity of cleft, and presence of other dentofacial abnormalities. This article describes the use and efficacy of different orthodontic, orthopedic, and surgical approaches at each developmental stage of unilateral and bilateral clefts, whereby the orthodontist plays a pivotal role in the different phases of growth and development of the cleft lip and the patient.

4.
Plast Reconstr Surg ; 145(4): 944-946, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221210

RESUMEN

Treatment of nasal deformity and obstruction requires analysis, planning, and precise execution of rhinoplasty techniques. When performed well, rhinoplasty is a powerful tool for achieving appealing nasal morphology and optimizing function. This article aims to highlight an open approach to septorhinoplasty using a number of techniques that are preferred by the senior author (D.M.S.) to successfully correct a congenital nasal deformity and deviated septum.

5.
Plast Reconstr Surg ; 145(4): 790e-802e, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221226

RESUMEN

BACKGROUND: Apert syndrome causes normal or enlarged intracranial volume overall as patients grow. This study aimed to trace the segmental anterior, middle, and posterior cranial fossae volume and structural morphology in these patients, to help discern a more focused and individualized surgical treatment plan for patients with Apert syndrome. METHODS: This study included 82 preoperative computed tomographic scans (Apert, n = 32; control, n = 50) divided into five age-related subgroups. The scans were measured using image processing and three-dimensional modeling software. RESULTS: The middle cranial fossa volume was increased and was the earliest change noted. It was increased by 45 percent (p = 0.023) compared with controls before 6 months of age and remained increased into adulthood (161 percent, p = 0.016), with gradually increasing severity. The anterior and posterior cranial fossae volumes also increased, by 35 percent (p = 0.032) and 39 percent (p = 0.007), respectively. Increased depth of cranial fossae contributed most to the increase in volumes of patients with Apert syndrome, with correlation coefficients of 0.799, 0.908, and 0.888 for anterior, middle, and posterior cranial fossa, respectively. The intracranial volume was increased 12 percent (p = 0.098) across the entire test age range (0 to 26 years old), but only had statistical significance during the age range of 6 to 18 years (22 percent, p = 0.001). CONCLUSIONS: Malformation of the middle cranial fossa is an early, perhaps the initial, pivotal cranial morphologic change in Apert syndrome. Increased cranial fossae depth is an inherent characteristic of the maldevelopment. Normalization of cranial volume and circumference overall may not achieve a normal skull structure, as it does not correct regional craniocerebral disproportion.

6.
Ann Plast Surg ; 2020 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-32187073

RESUMEN

INTRODUCTION: Increased awareness for transgender and gender-nonconforming individuals may lead to increased demand for surgical interventions in gender-confirming care. However, limited literature exists regarding transgender and gender-nonconforming preferences and experiences with medical or surgical care. The authors aim to characterize the medical and surgical care sought by this population, as well as their surgical preferences, motivations, and barriers to care. METHODS: An online questionnaire about opinions and personal experiences with medical and surgical care during gender transition was publicized via regional online social networking forums in Connecticut and surrounding areas catering to transgender communities. RESULTS: Responses were received from 313 participants. Participants were 97% male gender at birth and 92% white with an average (SD) age of 51.6 (13.5) years. Fifty-nine percent identified as male-to-female transgender and 20% as gender nonconforming. Respondents were aware of their gender identity at a mean (SD) age of 9.6 (9.0) years, but did not begin transitioning until a mean (SD) age of 38.9 (20.8) years, with gender-nonconforming respondents choosing to transition at a significantly younger age as compared with transgender respondents (29.8 vs 41.4 years; P = 0.0061, unpaired t test). Only 42% of all respondents, with a significantly greater number of transgender as opposed to gender-nonconforming individuals, had previously met with a physician to discuss transitioning (49% vs 21%, P = 0.002, χ test). Eight percent of the study population had undergone gender confirmation surgery (GCS), 52% were interested in GCS, and 40% were not interested in GCS. Primary motivation for GCS included discomfort in one's current body (28%), and barriers to GCS included cost (40%) and reactions of family (40%), partners (32%), and friends (25%). CONCLUSIONS: Transgender and gender-nonconforming individuals lack medical support for gender transition, with fewer than half of survey respondents reporting a prior meeting with a physician to discuss transitioning. The reported perspectives offer important insight into transgender preferences that should act as the basis of future efforts to improve the efficacy of gender-confirming care.

7.
J Craniofac Surg ; 31(3): 673-677, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049910

RESUMEN

BACKGROUND: Based on an established classification system of Crouzon syndrome subtypes, detailed regional morphology and volume analysis may be useful, to clarify Crouzon cranial structure characteristics, and the interaction between suture fusion and gene regulated overall growth of the calvarium and basicranium. METHODS: CT scans of 36 unoperated Crouzon syndrome patients and 56 controls were included and subgrouped as: type I. Bilateral coronal synostosis; type II. Sagittal synostosis; type III. Pansynostosis; type IV. Perpendicular combination synostosis. RESULTS: Type I of Crouzon syndrome patients developed a slightly smaller posterior fossa (22%), and increased superior cranial volume (13%), which is the only subtype that develops a greater superior cranial volume. The effect of competing increased and decreased segmental volume is associated with a 24% enlargement of overall cranial volume (P = 0.321). In class III, the anterior fossa volume was increased by 31% (P = 0.007), while the volume of posterior fossa was decreased by 19% (P < 0.001). These resulted in a 7% (P = 0.046) reduction in the overall intracranial volume. Type II and type IV patients developed a trend toward anterior, middle, and posterior fossae, and entire cranial volume reduction. CONCLUSIONS: Pansynostosis is the most often form of associated craniosynostoses of Crouzon syndrome, however bilateral coronal synostosis may not dominate this form of Crouzon syndrome. The anterior, middle and posterior cranial fossae may have simultaneously reduced volume if the midline suture synostosis is involved. Individualized treatment planning for Crouzon syndrome patient, theoretically should include the patient's age and temporal associated maldevelopment suture sequence.

8.
J Craniofac Surg ; 31(3): 678-684, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32068731

RESUMEN

BACKGROUND: Patients with Crouzon syndrome develop various types of anatomic deformities due to different forms of craniosynostosis, yet they have similar craniofacial characteristics. However, exact homology is not evident. Different pathology then may be best treated by different forms of surgical technique. Therefore, precise classification of Crouzon syndrome, based on individual patterns of cranial suture involvement is needed. METHODS: Ninety-five computed tomography (CT) scans (Crouzon, n = 33; control, n = 62) were included in this study. All the CT scans are divided into 4 types based on premature closure of sutures: class I = coronal and lambdoidal synostosis; class II = sagittal synostosis; class III = pansynostosis; and class IV = "Others." The CT scan anatomy was measured by Materialise software. RESULTS: The class III, pansynostosis, is the most prevalent (63.6%). The classes I, III, and IV of Crouzon have significantly shortened entire anteroposterior cranial base length, with the shortest base length in class III. The external cranial measurements in class I show primarily a decreased posterior facial skeleton, while the class III presented with holistic facial skeleton reduction. Class II has the least severe craniofacial malformations, while class III had the most severe. CONCLUSION: The morphology of patients with Crouzon syndrome is not identical in both cranial base and facial characteristics, especially when they associated with different subtypes of cranial suture synostosis. The classification of Crouzon syndrome proposed in this study, summarizes the differences among each subgroup of craniosynostosis suture involvement, which, theoretically, may ultimately influence both the timing and type of surgical intervention.

9.
Plast Reconstr Surg ; 145(2): 518-521, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985651

RESUMEN

The mature bilateral cleft nasolabial deformity exhibits prolabial and vermilion deficiency, a broad depressed nasal tip, and short columella. Many strategies attempt to correct these stigmata, with varying degrees of success. The purpose of this communication is to describe a novel sequenced approach, staging an Abbe flap and rhinoplasty, with morphometric analysis of results. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Asunto(s)
Labio Leporino/cirugía , Rinoplastia/métodos , Colgajos Quirúrgicos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Satisfacción del Paciente , Resultado del Tratamiento , Adulto Joven
10.
Aesthet Surg J ; 40(4): 359-366, 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-30868159

RESUMEN

BACKGROUND: Autologous fat is a safe and effective soft tissue filler. Recent evidence also suggests improved wound healing and immune modulation with fat grafting. OBJECTIVES: The aim of this study was to describe a novel technique utilizing fat grafting during primary open rhinoplasty. We hypothesize a more rapid resolution of bruising and edema. METHODS: Patients who underwent rhinoplasty were reviewed and compared by presence or absence of concurrent fat grafting. Three-dimensional images were analyzed employing Mirror (Vectra, Canfield Scientific, NJ). Ecchymoses were outlined utilizing a magnetic lasso followed by an area measurement. Volumetric edema measurements were also taken and assessed. Edema and ecchymosis were measured at 2 and 6 weeks postoperatively. Statistical significance was defined as P < 0.05. RESULTS: Sixty-two patients were included. Thirty-three patients (53.2%) received autologous fat grafting and 29 (46.8%) did not. Age, gender, surgical approach, and osteotomy distribution were similar between the groups. The fat grafted group showed 7.29 cm2 fewer ecchymoses (P < 0.001) and 0.73 cc less edema (P = 0.68) in the early postoperative interval. Six weeks postoperatively, the fat grafted group showed 1 cc less edema (P = 0.36) with negligible differences in bruising. CONCLUSIONS: Autologous fat grafting is a useful adjunct to rhinoplasty and is associated with significantly fewer ecchymoses in the acute postoperative period.

11.
Plast Reconstr Surg ; 145(1): 117e-125e, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31592950

RESUMEN

BACKGROUND: De novo or rare transmitted mutations in the SMAD6 gene affect 7 percent of midline nonsyndromic synostosis patients. This study aimed to determine the neurocognitive sequelae of SMAD6 synostosis. METHODS: Nonsyndromic synostosis patients 6 years or older with SMAD6 mutations and non-SMAD6 nonsyndromic synostosis controls were recruited. All patients completed a double-blinded neurodevelopmental battery (i.e., Wechsler Fundamentals, Wechsler Abbreviated Scale of Intelligence, Beery-Buktenica Developmental test), and parents/guardians completed behavioral surveys (Behavior Rating Inventory of Executive Function and Behavior Rating System for Children). RESULTS: Twenty-eight patients participated: 10 known SMAD6 patients (average age, 10 years; 1 female; eight metopic and two sagittal; nine treated with cranial vault remodeling and one treated with strip craniectomy) and 18 non-SMAD6 controls (age, 9.5 years; three female; 12 metopic and six sagittal; 17 treated with cranial vault remodeling and one treated with strip craniectomy). There were no differences between any demographics. Testing age, surgical age, parental education, and household income correlated with cognition (p < 0.05). After controlling for these factors, SMAD6 patients performed worse on numerical operations (p = 0.046), performance intelligence quotient (p = 0.018), full-scale intelligence quotient (p = 0.010), and motor coordination (p = 0.043) compared to age/race/gender/synostosis/operation-matched controls. On behavioral surveys, SMAD6 patients scored worse on 14 assessments, including aggression, communication, and behavior. CONCLUSIONS: This prospective double-blinded study revealed that neuropsychiatric development of nonsyndromic synostosis may be under genetic control. SMAD6 mutations led to poorer mathematics, performance intelligence quotient, full-scale intelligence quotient, and motor coordination, even after controlling for exogenous factors. Genetic testing may be critical for advocating early adjunctive neurodevelopmental therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

12.
Ann Plast Surg ; 84(1): 117-122, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31633539

RESUMEN

BACKGROUND: The fibula free flap (FFF) remains the criterion standard for complex mandibular reconstruction. Surgeons have incorporated virtual surgical planning (VSP) into the reconstructive algorithm with the assertion that VSP increases operative efficiency and may improve clinical outcomes. To date, no large-scale studies have analyzed these claims. This study examines the literature and tests the hypothesis that VSP improves operative efficiency, clinical outcomes, and accuracy when compared with traditional techniques. METHODS: A systematic review was performed to identify articles utilizing VSP and traditional techniques for FFF-based mandibular reconstruction. Two reviewers independently assessed all articles for methodological quality using a validated instrument (weighted Cohen κ for interrater reliability = 0.70). Outcomes included operative time, length of stay, complications, and accuracy. Meta-analytic comparisons were performed using data from comparative studies using a random-effects model and differences of means analysis for outcomes measured on identical scales. RESULTS: One hundred thirty-one articles were identified, and 25 met the inclusion criteria: 12 were VSP only, whereas 13 were comparative. There were 241 VSP patients and 214 traditional patients available for meta-analysis. Patients undergoing reconstruction with VSP had a significant reduction in operative time by 44.64 minutes (95% confidence interval [CI], -74.69 to -14.58 minutes; P < 0.01) and demonstrated a mean trend toward shorter hospital admission (mean difference, -1.24 days; 95% CI, -4.00 to 1.52 days; P = 0.38). There was no statistical difference between cohorts for major (odds ratio, 1.03; 95% CI, 0.46-2.31; P = 0.95) or minor complications (odds ratio, 0.97; 95% CI, 0.54-1.71; P = 0.90). Insufficient data were available for cost analysis and accuracy. CONCLUSIONS: Virtual surgical planning-guided mandibular reconstruction with FFF is associated with significantly decreased operative time and a mean trend toward shorter hospital admission. While multiple studies reported a high degree of accuracy, no standard measurement was available for meta-analysis.

13.
Plast Reconstr Surg ; 145(1): 80-83, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31881606

RESUMEN

Facial aging patients frequently seek improved neck and jawline definition. Microgenia, or lack of chin support, is often overlooked or underdiagnosed in these patients. The authors propose a simultaneous genioplasty, in addition to platysmaplasty and face/neck lift, to address both soft-tissue and bony components, and enhance the cervicomental area. The platysmaplasty is performed in a novel fashion using the intraoral genioplasty incision. The operative sequence includes intraoral incision, platysmal exposure, fat excision, platysmal tightening, genioplasty osteotomy/fixation, and external skin redraping (face/neck lift). Case examples are shown to illustrate appropriate candidate selection and results. Parameters for success include increased chin-throat distance and definition, improved cervicomental angle, and soft-tissue rejuvenation. The novel approach the authors describe enables discrete access to the platysmal and submental region and provides bony definition to help optimize the soft-tissue drape and definition. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.


Asunto(s)
Mentoplastia/métodos , Boca/cirugía , Ritidoplastia/métodos , Anciano , Femenino , Humanos , Persona de Mediana Edad , Cuello/cirugía , Resultado del Tratamiento
14.
Plast Reconstr Surg ; 144(6): 1371-1383, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31764655

RESUMEN

BACKGROUND: Nonsyndromic craniosynostosis may manifest with complex behavioral, attentional, and emotional sequelae. The authors characterized higher level brain connectivity in adolescent nonsyndromic craniosynostosis patients in response to emotional frustration. METHODS: Surgically corrected patients older than 9 years with nonsyndromic craniosynostosis were age/sex/handedness matched to controls. Patients participated in a "go/no-go" task, structured as win/lose/recovery paradigms. BioImage Suite was used to analyze whole-brain intrinsic connectivity between tasks with cluster-corrected group-level t maps. A value of p < 0.05 was significant. RESULTS: Seven unilateral coronal (average age, 12.2 years), six metopic (average age, 11.5 years), and controls were included. Unilateral coronal had worse emotional regulation scores on the Behavior Rating Inventory of Executive Function survey (p = 0.065) and performed poorly on the go/no-go task (p < 0.001). Metopic had four regions of interest, with the majority having decreased activity compared with controls, and few differences between tasks. Unilateral coronal patients had 11 regions of interest; the majority decreased during the win and lose conditions, but all increased during the recovery condition. Metopic patients had decreased blood oxygenation level- dependent signal in the posterior cingulate (p = 0.017) and middle temporal gyrus (p = 0.042). Unilateral coronal had decreased signal in the posterior cingulate (p = 0.023), middle temporal gyrus (p = 0.027), and thalamus (p = 0.033), but increased signal in the cuneus (p = 0.009) and cerebellum (p = 0.009). Right unilateral coronal, but not metopic/controls, had increased right brain activity in the caudate (p = 0.030), thalamus (p = 0.011), temporal lobe (p = 0.012), and cerebellum (p = 0.029). CONCLUSIONS: Unilateral coronal patients may have emotional dysregulation in response to frustration, whereas metopic patients may have attenuated emotional reactions. Evidence of right unilateral coronal brain laterality suggests that the area of suture fusion may contribute to the mechanism of dysfunction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Asunto(s)
Craneosinostosis/psicología , Regulación Emocional/fisiología , Frustación , Estudios de Casos y Controles , Niño , Craneosinostosis/sangre , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Oxígeno/sangre , Estudios Prospectivos , Pruebas Psicológicas
16.
J Craniofac Surg ; 30(8): 2345-2349, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31609946

RESUMEN

BACKGROUND: Based on an established classification system of Apert syndrome subtypes, detailed regional morphology and volume analysis may be useful to provide additional clarification to individual Apert cranial structure characteristics, and treatment planning. METHODS: Computed tomography scans of 32 unoperated Apert syndrome and 50 controls were included and subgrouped as: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combination synostosis. Three-dimensional analysis of craniometric points was used to define structural components using Materialise Mimics and 3-Matics software. RESULTS: Occipitofrontal circumference of all subtypes of Apert syndrome patients is normal. Intracranial volumes of types I and II were normal, but type III was 20% greater than controls. Middle cranial fossa volume was increased in all 3 types, with the greatest increase in type II (86%). Type II developed a 69% increase in anterior cranial fossa volume, whereas type III had 39% greater posterior cranial fossa volume. Increased cranial fossa depth contributed most to above increased volume. The anteroposterior lengths of middle and posterior cranial fossae were reduced in type I (15% and 17%, respectively). However, only the anterior cranial fossa was significantly shortened in type III. CONCLUSIONS: Occipitofrontal circumference and overall intracranial volume is not always consistent in individual subunits of Apert syndrome. Detailed and segmental anterior, middle, and posterior cranial fossae volumes and morphology should be analyzed to see what impact this may have related to surgical planning.


Asunto(s)
Acrocefalosindactilia/diagnóstico por imagen , Acrocefalosindactilia/cirugía , Cefalometría , Fosa Craneal Anterior/diagnóstico por imagen , Fosa Craneal Anterior/cirugía , Fosa Craneal Media/diagnóstico por imagen , Fosa Craneal Media/cirugía , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/cirugía , Femenino , Humanos , Masculino , Tomografía Computarizada por Rayos X
18.
Sci Rep ; 9(1): 13597, 2019 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-31537815

RESUMEN

Current computational tools for planning and simulation in plastic and reconstructive surgery lack sufficient precision and are time-consuming, thus resulting in limited adoption. Although computer-assisted surgical planning systems help to improve clinical outcomes, shorten operation time and reduce cost, they are often too complex and require extensive manual input, which ultimately limits their use in doctor-patient communication and clinical decision making. Here, we present the first large-scale clinical 3D morphable model, a machine-learning-based framework involving supervised learning for diagnostics, risk stratification, and treatment simulation. The model, trained and validated with 4,261 faces of healthy volunteers and orthognathic (jaw) surgery patients, diagnoses patients with 95.5% sensitivity and 95.2% specificity, and simulates surgical outcomes with a mean accuracy of 1.1 ± 0.3 mm. We demonstrate how this model could fully-automatically aid diagnosis and provide patient-specific treatment plans from a 3D scan alone, to help efficient clinical decision making and improve clinical understanding of face shape as a marker for primary and secondary surgery.

19.
Plast Reconstr Surg ; 144(5): 772e-780e, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31373990

RESUMEN

BACKGROUND: Control and maintenance of nasal tip position are critical in rhinoplasty. Two frequent methods of exerting tip control are columellar strut and caudal septal extension graft. However, no quantitative data exist comparing the two methods over time. The purpose of this study was to analyze maintenance of tip projection and rotation following either columellar strut or septal extension graft. METHODS: A retrospective cohort study of patients undergoing rhinoplasty was reviewed. Three-dimensional photogrammetric evaluation of patients with either columellar strut or septal extension graft to increase tip projection was performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, the Goode ratio, and tip rotation. Results were stratified based on technique and compared statistically. RESULTS: One hundred six patients were included. Overall, 66 percent were female, with an average age of 34.5 years. A columellar strut was used in 42 percent of cases (n = 45), and a septal extension graft was used in 57 percent (n = 61). Analysis showed greater maintenance of tip rotation over time with the septal extension graft compared with the columellar strut [-1.01 percent change (p = not significant versus -5.08 percent change (p = 0.009)]. Tip projection, nasal length, and the Goode ratio decreased over time for both groups, but the differences were not statistically different. CONCLUSIONS: Nasal tip projection and rotation appear to decrease from the immediate postoperative position. In this study, both septal extension graft and columellar strut exhibit similar changes in tip projection with time; however, septal extension graft is better able to preserve tip rotation compared with the columellar strut. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Cartílagos Nasales/trasplante , Tabique Nasal/cirugía , Fotogrametría , Rinoplastia/métodos , Adulto , Estudios de Cohortes , Estética , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prótesis e Implantes , Estudios Retrospectivos , Medición de Riesgo , Técnicas de Sutura , Resultado del Tratamiento
20.
J Craniofac Surg ; 30(8): 2601-2603, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449227

RESUMEN

Correction of facial asymmetry caused by active unilateral condylar hyperplasia (CH) requires proper diagnosis, arrested ongoing condylar growth, and ultimately orthognathic surgery. Traditionally, prior to performing orthognathic surgery, active CH is addressed either by: awaiting natural cessation of condylar overgrowth, or performing an interval high condylectomy (to stop growth). However, these strategies both add to the total treatment time, by either waiting and confirming no active growth, or performing a first stage growth-arresting procedure. In this report, the authors describe concurrent high condylectomy, and 3-jaw orthognathic surgery, to address the root of the problem and provide aesthetic correction in the same setting. This clinical series illustrates a detailed description of this approach, highlighting operative order, and an analysis of outcomes.


Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Femenino , Humanos , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto Joven
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