SMAS flap for extracapsular dissection of parotid gland tumors: is it necessary?

OBJECTIVE: The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3 cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. METHODS: Two groups were created and statistically compared regarding Frey's syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. RESULTS: The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). CONCLUSION: In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3 cm for which extracapsular dissection is adopted as a surgical technique.

Modified Endaural Approach With a Peripheral Dissection of the Superficial Musculoaponeurotic System to Access the Temporomandibular Joint to Prevent Facial Nerve Injury.

The purpose of this study was to assess the effects of protecting the facial nerve with a modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint which allows an excellent operative field of visualization, multiple surgical procedures of the temporomandibular joint, and general care which improves the immediate postoperative period, making this a less morbid surgery. This study included 33 patients (39 sides) who underwent surgical treatment for disorders of the temporomandibular joint from the years 2021 to 2023 at the maxillofacial department of the clinic "Colsanitas" located in Bogota, Colombia. Therapeutic results were evaluated by postoperative facial nerve injury, with the House-Brackman scale; every patient was examined for adequate facial musculature function immediately after surgery. Notably, zero patients presented facial nerve injury. These results imply that the modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint reduces the incidence of facial nerve injuries, improves operative site exposure, and lowers the frequency of complications.

La importancia del conocimiento de la anatomía facial en armonización facial / The knowledge of facial anatomy in facial harmonization

La odontología argentina ha considerado reciente- mente la incorporación de armonización orofacial en odontología, acompañando los cambios que vienen sucediendo en el mundo con respecto a este tema. Países con especialización en armonización orofacial en odontología, como Brasil, 2019 o Venezuela, 2020, son muestra de ello. La evolución de la tecnología, junto con los cambios de paradigmas de la sociedad, ha cambiado aún el con- cepto de tratamiento desde la OMS. Actualmente bus- ca, como beneficio para los pacientes, el bienestar físico mental y social, no solo tratar o prevenir patologías. Acompañando estos conceptos las ciencias se adap- tan también a las necesidades de la población. El conocimiento de la anatomía facial también ha avanzado gracias a la tecnología y volumen de trabajos científicos desarrollados para conocer en profundidad cada una de las estructuras faciales y su relación entre ellas. Para ello ha sido fundamental la preparación actualizada de profesionales que traba- jan abordando tejidos blando de cara y cuello (AU)

Argentine dentistry has recently considered the incorporation of Orofacial Harmonization in Dentistry accompanying the changes that have been happening in the world regarding this issue, countries specializing in Orofacial Harmonization in Dentistry such as Brazil 2019 or Venezuela 2020 are proof of this. The evolution of technology together with the paradigm shifts of society has changed still the concept of treatment from the OMS Looking for a benefit for patients physical mental and social well-being and not only treat or prevent pathologies. Accompanying these concepts, the sciences also adapt to the needs of the population. Knowledge of facial anatomy has also advanced thanks to technology and volume of scientific works developed to know in depth each one of the structures facial features and their relationship between them, being essential the updated preparation of the professionals who work addressing soft tissues of the face and neck (AU)

Minilifting technique for treatments of the lower third of the face and anterior cervical neck with tumescent anesthesia.

BACKGROUND: Minimally invasive surgical techniques with a low rate of complications and rapid return to daily activities are in high demand for dermatological procedures and include lasers, microfocused ultrasound, botulinum toxin, suture strings, and filling techniques with hyaluronic acid. The facelift, on the other hand, has been criticized for complications such as bruising, relatively slow recovery rates (lasting up to a month), facial nerve lesions, and flap necrosis. Earliest descriptions of the facelift technique described a procedure associated with skin traction and detachment. However, authors did not describe a method for SMAS plication, which is still somewhat controversial. AIMS: Describe a surgical technique that reduce the signs of aging on the lower third of the face and neck with low rate of complications. METHODS: The minilifting technique described herein is capable of repositioning the superficial muscular aponeurotic system (SMAS) and removing excess skin from the neck and lower third of the face with minimal detachment, local tumescent anesthesia, a few complications, and a relatively fast return to daily activities (15 days). CONCLUSION: Performance of a deep dissection and excision of part of the SMAS with posterior sutures is believed to be an optimal approach, whereas authors believe that a superficial dissection is safer and provides similar outcomes compared to deep dissection. This procedure produces extremely natural and long-lasting results.

Tratamento da flacidez músculo aponeurótica acentuada da parede abdominal, experiência de 26 anos / Treatment of marked abdominal wall musculoaponeurotic flaccidity: 26 years of experience

Realizamos uma análise de quais são os elementos responsáveis pelo sustento e formato abdominal, determinando assim, que é devido a uma excessiva flacidez musculoaponeurótica de origem primária, à qual promove uma incapacidade do suporte da parede abdominal e pode estar relacionada a fatores predisponentes. Para esses casos específicos, desenvolvemos um tratamento propondo a colocação da tela e apresentando nossa experiência. Apresentamos esta série de casos de experiência em 26 anos. Onde 15 pacientes foram tratados com abdominoplastia primária e secundária. O reforço da parede abdominal foi realizado através da colocação de tela de polipropileno no plano submuscular com pontos em U na fáscia transversalis, buscando-se fortalecer o músculo e a fáscia transversa. Os resultados foram satisfatórios a longo prazo. Obtendo resolução das protuberâncias abdominais e restaurando a harmonia dos músculos. Apenas duas complicações ocorreram, que foram a presença de dor crônica localizada no abdome tratada com infiltrações de esteroides e fístula umbilical precoce de resolução rápida espontânea, independente da proposta.

We investigated the causative factors of abdominal support and shape and found that excessive musculoskeletal flaccidity of primary origin causes an inability to support the abdominal wall and may be associated with the predisposing factors. For such cases, we developed a treatment consisting of the placement of a subcutaneous mesh. Here, we present our experience with this treatment. We present a case series of 15 patients in our 26 years of experience who were treated with primary and secondary abdominoplasties. The abdominal wall was reinforced by placing a polypropylene mesh in the submuscular plane with U-stitches in the transversalis fascia, aiming at strengthening the muscle and transverse fascia. The results were satisfactory in the long term. Abdominal bulges were repaired, and muscle harmony was restored. Only two complications occurred: chronic pain localized in the abdomen, which was treated with steroid infiltrations, and an early umbilical fistula with spontaneous and rapid resolution, regardless of the proposal.

Injertos de Recubrimiento en Rinoplastia Una nueva propuesta / Nasal autologus grafts in Rinoplasty A new propousal

El objetivo de este artículo es exponer nuestra experiencia en el uso de injertos de recubrimiento para la punta y el dorso nasal. Se mostrará detalladamente la técnica quirúrgica por medio de un abordaje abierto y una serie de 59 pacientes en quienes se colocaron injertos de recubrimiento obtenidos del SMAS (sistema músculo aponeurótico superficial) y su seguimiento. Esta técnica no descrita previamente se presenta como una alternativa que podría ser de utilidad para los otorrinolaringólogos y cirujanos plásticos faciales. La principal ventaja que ofrece esta técnica, es la prevención de retracciones y favorecer el camuflaje de los injertos nasales, especialmente postes y escudos bajo pieles delgadas, con el fin de obtener resultados más naturales y consistentes a largo plazo.

The aim of this article is to present our experience in the use of coverage grafts for the tip and dorsum of the nose. A detailed description of the technique is shown, via an open rhinoplasty approach. Selected cases, in which a graft harvested from the SMAS (nasal superficial musculoaponeurotic system) was used, are depicted for pre and postoperative comparison. This technique is suggested as a useful surgical alternative for otolaryngologists and facial plastic surgeons. The main advantages of this technique is the prevention of retractions and an appropriate camouflage of nasal grafts, especially struts and shields underlying thin nasal skin, in order to achieve more natural and aesthetic results, consistent in the long term.

Cervicoplastia con suspensión dinámica del platisma / Cervicoplasty with dinamic suspension of platysma

Introducción: La Cervicoplastia es una Técnica quirúrgica diseñada para corregir la ptosis congénita o senil del músculo platisma del cuello y la piel que lo recubre. Diseño: Observacional descriptivo tipo serie de casos. Metodología: Previa firma del consentimiento informado. 96 pacientes operados en la práctica privada del autor en la ciudad de Cartagena, desde Enero/08 hasta Diciembre/15. Fotografías prequirúrgicas en las siguientes vistas: frente, perfiles, semiperfiles, con la cabeza en flexión y extensión, exámenes de laboratorio y fotografía post-quirúrgica, las cuales fueron tomadas a los 8,15, 30, 60, 90, 120, 360 días y 2 años después de la cirugía. Registro en la historia clínica del grado de satisfacción del paciente como: felices, satisfechos o insatisfechos. Resultados: De los 96 pacientes operados 89 (92.7%) manifestaron estar felices, 5 (5.2%) se engordaron y se refirieron como Satisfechos y 1 (1.04%) se declaró "insatisfecho", por cicatriz hipertrófica en la incisión submental. Conclusiones: Por la completa corrección de la ptosis del platisma y de piel del cuello; así como la posibilidad de hacer procedimientos complementarios por la misma vía de abordaje, con alta tasa de felicidad de los pacientes (92.7%) la Cervicoplastia con suspensión dinámica del platisma se ha convertido en el procedimiento estándar por el autor para rejuvenecer el cuello y el tercio inferior facial.

Introduction: Cervicoplasty is a technique to fix congenital or senile ptosis, from the platisma muscle and the skin that surrounds it. Design: Case series study. Method: Previous informed consent signed up, 96 patients submitted to this study, which already had such procedure, in Cartagena de Indias from January of 2008 to December 2015. Using pre-surgical photography, with the following view: front, side face, and with the head on flexion and extension. Laboratory exams, and post-Surgical photography, which have been taken at 8, 15, 30, 60, 90, 120, 360 days and 2 years after the surgery is made. Alongside the help of medical history records, and satisfaction grades from the patients as: happy, satisfied and unsatisfied. Results: From the 96 patients, 89 (92.7%) acclaimed to be mostly happy, 5 (5.2%) got fatter on time and acclaimed to be satisfied with the procedure, and 1 (1.04%) declared himself unsatisfied, as he has a hypertrophic scar on the lower chin incision. Conclusions: The complete correction of the platisma and neck skin ptosis, as well as the possibility of having complementary procedures on the same incision, exists a high rate of satisfied patients (92.7%), which makes the Cervicoplasty with dynamic suspension of the platisma the standard procedure for the author, in order to embellish the neck and the facial inferior third.

Método de avaliação da suspensão do SMAS no rejuvenescimento facial / A method to evaluate the SMAS suspension in facelift

INTRODUÇÃO: A suspensão do sistema musculoaponeurótico superficial (SMAS) é um procedimento amplamente aceito nas ritidoplastias. Com o objetivo de avaliar a eficácia de tal suspensão na técnica de tratamento do SMAS em round block com cicatrizes curtas, foi proposto método em que a redução da área descolada é avaliada ao final da cirurgia, assegurando sua eficácia, baseada em clara evidência. MÉTODO: Foram analisadas 20 cirurgias consecutivas de ritidoplastia, todas realizadas pelo mesmo cirurgião, com os mesmos padrões. Foram tomadas 12 medidas em cada lado da face, 7 antes e 5 após a realização da suspensão, permitindo a elaboração de 40 diagramas compreendendo as áreas avaliadas antes e após o procedimento. Foi utilizado o software ImageJ (NIH Image) para cálculo das áreas. RESULTADOS: A área descolada nas 40 medidas apresentou média de 52,6 cm², mudando para 32,6 cm² após a suspensão, com redução média de 38%. Os diagramas obtidos refletiram a exata atuação nos diversos pontos da face. CONCLUSÕES: O método descrito confirma que a técnica é eficiente quanto à suspensão do SMAS, com redução significativa da área descolada e consequente diminuição do espaço morto pós-operatório, e pode servir como parâmetro para comparação de diferentes técnicas.

BACKGROUND: The superficial musculo-aponeurotic system (SMAS) suspension is a globally accepted procedure in rhytidoplasties. In order to evaluate the efficacy of suspension performed with the round block SMAS treatment, the authors planned a method in which the wound area reduction is measured to assure its functionality, based in clear evidence. METHODS: Twenty consecutive rhytidoplasties were evaluated, all of them done by the same surgeon, using the same standards. Twelve measures were taken in each side of the face, 7 before suspension and 5 after, allowing for the elaboration of 40 diagrams comprising the areas evaluated before and after suspension. The software ImageJ (NIH Image) was used to evaluate the surfaces. RESULTS: The undermined area in the 40 measures had a mean of 52.6 cm², which changed to a mean of 32.6 cm² after suspension, with a mean reduction of 38%. The diagrams also showed the exact handled points of the face. CONCLUSIONS: The described methodology confirms that the round block SMAS treatment technique is efficient regarding the suspension of the superficial muscular aponeurotic system, with significant reduction of the undermined area, consequently reducing the dead space, and may be a parameter to comparison of different techniques.

Minimally invasive lift of the middle third of the face using musculoaponeurotic suspension with periosteal fixation technique: a review of 50 cases / Suspensão musculoaponeurótica com fixação periostal minimamente invasiva do terço médio da face: revisão de 50 casos

BACKGROUND: At present, demanding workplaces in our society cause patients to search for less invasive procedures with diminished morbidity and more rapid healing to meet their cosmetic requirements. A combination of several new noninvasive procedures allows significant facial changes, achieving a youthful and healthy appearance without traditional surgical procedures. OBJECTIVE: The purpose of this study is to describe the minimally invasive lift of the middle third of the face using a musculoaponeurotic suspension with periosteal fixation technique. METHODS: Fifty patients (age, 39 to 68 years; all female) who underwent an operation from December 2008 to June 2010 were enrolled in this study. The patients underwent a minimally invasive facelift technique for the middle third of the face, based on a thread lift of the temporal region and musculoaponeurotic suspension with periosteal fixation, inside the hairline. RESULTS: During the follow-up period of up to 18 months after the procedure, satisfactory results were observed. The patient satisfaction degree, especially in the first 6 months after the procedure, was extremely high (88 percent). CONCLUSIONS: The procedure offers good and immediate results, without incisions or a recovery period. The association of this procedure with other procedures is a good option for patients who cannot undergo or do not want to undergo traditional surgical procedures. The procedure is very different from current techniques that use threads because the suspension is musculoaponeurotic and does not invade the face. Therefore, morbidity and recovery time are decreased.

INTRODUÇÃO: Na sociedade atual, em decorrência das demandas profissionais, os pacientes cada vez mais procuram por procedimentos menos invasivos, com baixa morbidade, rápida recuperação, e que atendam a suas preocupações estéticas. Uma combinação de vários novos procedimentos não-invasivos permite mudanças faciais significativas e aparência jovem e saudável, sem a utilização de procedimentos cirúrgicos tradicionais. OBJETIVO: O objetivo deste estudo é a descrição de técnica de suspensão musculoaponeurótica com fixação periostal minimamente invasiva do terço médio da face. MÉTODO: Foram incluídos nesse estudo 50 pacientes, com idades entre 39 anos e 68 anos, todos do sexo feminino, operados no period de dezembro de 2008 a junho de 2010. As pacientes foram submetidas à realização de facelift minimamente invasivo do terço médio da face, com suspensão musculoaponeurótica com fixação periostal, baseado na tração com fio passado na região temporal, dentro da área do cabelo. RESULTADOS: No acompanhamento das pacientes, até 18 meses após a realização do procedimento, verificaram-se resultados satisfatórios. O grau de satisfação das pacientes com os resultados obtidos, principalmente nos primeiros seis meses após a realização do procedimento, foi extremamente alto (88 por cento). CONCLUSÕES: O procedimento ofereceu bons e imediatos resultados, sem incisões ou período de recuperação. Associado a outros procedimentos de rejuvenescimento facial, trata-se de boa opção a pacientes que não podem ou não querem se submeter a procedimentos cirúrgicos tradicionais. O procedimento difere significativamente das técnicas atuais que usam fios, pois a suspensão é musculoaponeurótica e não invade a área da face, o que diminui a morbidade e o período de recuperação.