Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.388
Filtrar
1.
Am J Orthod Dentofacial Orthop ; 157(2): 259-268, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005478

RESUMEN

This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.


Asunto(s)
Craneosinostosis , Estética Dental , Asimetría Facial , Osteotomía Le Fort , Adolescente , Craneosinostosis/complicaciones , Craneosinostosis/cirugía , Asimetría Facial/cirugía , Huesos Faciales , Humanos , Masculino
2.
J Craniofac Surg ; 31(1): 64-67, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31469732

RESUMEN

Autologous free fat graft is a widely accepted method of facial contour restoration in Parry-Romberg syndrome (PRS); however, complex and unpredictable facial anatomy can render this surgery extremely challenging. The integration of 3-dimensional (3D) technology strategies as a method to enhance surgical aesthetic outcomes has been demonstrated.A retrospective chart review was performed for PRS with autologous, free fat graft between 2016 and 2017. Based on 3D volumetric facial analysis and presurgical simulation, a 3D printed fat graft guide was produced. Surgical outcomes were analyzed by volumetric measurements of the upper, middle, and lower face segments.A total of 9 patients were included in the study. Their upper and middle facial volumes before and after the procedures showed statistically significant volume augmentation (upper face, P = 0.004; middle face, P = 0.002) 6 months postoperatively (T1). Facial asymmetry was also statistically significantly corrected (middle face P = 0.012; lower face P = 0.025) at 1 year after the procedure (T2).The advantageous application of 3D comprehensive technology for aesthetic improvements in patients with PRS with autologous, free fat graft treatment has been demonstrated. Precise preoperative planning based on simulations and postoperative 3D volumetric analyses can help adequately predict fat graft strategies.


Asunto(s)
Tejido Adiposo/trasplante , Hemiatrofia Facial/cirugía , Adolescente , Adulto , Asimetría Facial/cirugía , Femenino , Humanos , Periodo Posoperatorio , Impresión Tridimensional , Estudios Retrospectivos , Trasplante Autólogo
3.
Int J Pediatr Otorhinolaryngol ; 128: 109726, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31639620

RESUMEN

BACKGROUND: Total auricular reconstruction for hemifacial microsomia patients with extremely low hairline is a tough challenge in plastic surgery. In this work, a brand new technique using a singer expanded scalp flap without skin graft and combined with intense pulse light treatments (IPLT) for ear reconstruction is described in this special population. METHODS: From January 2015 to April 2019, 41 hemifacial macrosomia (HFM) patients with 70-100% low hairline were enrolled in our study. Operative treatment was performed in 3 stages: 1. Expander insertion and inflation; 2. Expander removal, costal cartilage framework fabrication and auricular reconstruction; 3. Tragus reconstruction and reconstructed auricle refinement. Several IPLTs were performed every 45 days until local area become hairless during the whole course. The first IPLT could be executed either before all the operations or during the expansion period. The flap was treated with M22 system using a filter of 695-1200 nm. Follow up ranged from 10 months to 4 years. RESULTS: During follow-up, 90.2% patients were surveyed as satisfied with the outcome, especially in the aspects of minimal scars, natural matched color and clear contour of the reconstructed ear. No serious complications happened. Patients starting the IPLT during the expansion period required less treatment times of depilation (p < 0.05). CONCLUSION: Auricular reconstruction using a single expanded scalp flap combined with intense pulse light depilation is a safe, effective and less invasive technique for hemifacial microsomia with extremely low hairline, and providing highly satisfying results. Initialing the IPLD during the expansion period is recommended. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Oído Externo/anomalías , Oído Externo/cirugía , Asimetría Facial/cirugía , Adolescente , Niño , Asimetría Facial/congénito , Femenino , Humanos , Tratamiento de Luz Pulsada Intensa , Masculino , Procedimientos Quirúrgicos Reconstructivos/métodos , Cuero Cabelludo , Expansión de Tejido
4.
J Craniofac Surg ; 30(8): 2390-2392, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31633668

RESUMEN

INTRODUCTION: Lambdoid craniosynostosis is an extremely rare anomaly in which there is premature fusion of one or both lambdoid sutures. The mainstay of treatment is surgical intervention, for which various procedures have been described, but there is a paucity of data on long-term outcomes. This study examines the long-term outcomes in the surgical management of this challenging condition, showing that accurate diagnosis and careful planning can lead to safe and consistent results. MATERIALS AND METHODS: A retrospective chart review was performed looking at all cases of isolated lambdoid craniosynostosis treated with surgical intervention by the senior author from 1999 to 2016. Data collected included gender, age at diagnosis, age at surgery, length of follow up, method of diagnosis, side of affected suture, pre-operative and post-operative physical exam findings, surgical technique, complications, re-operation rate, and associated torticollis. RESULTS: Twenty-five patients (N = 25) were included in the study. All patients underwent posterior calvarial remodeling with/without barrel stave osteotomies and full thickness calvarial bone grafts. Mean length of follow up after operative intervention was 43.8 months (+/- 23.2 months). All patients were judged to have significantly improved head contour which was near-normal at conversational distance during post-operative follow up by the senior author. Residual plagiocephaly was present in 24% of patients. There were no major complications in this series. Reoperation rate was 8%. Seventy-six percent of patients also presented with torticollis, of which 37% had refractory torticollis that required sternocleidomastoid (SCM) release by the senior author. DISCUSSION: The authors present one of the largest series of operative cases of isolated lambdoid craniosynostosis to date. Our data show that with accurate diagnosis and careful planning, safe and consistent long-term results can be achieved with surgical intervention. A significant number of patients in our series also presented with concomitant torticollis. The authors recommend that all patients being evaluated for posterior plagiocephaly should also be evaluated for torticollis, because without recognition and intervention, patients may continue to have residual facial asymmetry and head shape abnormalities despite optimal surgical correction of the lambdoid synostosis.


Asunto(s)
Craneosinostosis/cirugía , Trasplante Óseo , Asimetría Facial/cirugía , Humanos , Procedimientos Neuroquirúrgicos , Osteotomía , Plagiocefalia/cirugía , Periodo Posoperatorio , Reoperación , Estudios Retrospectivos , Cráneo/cirugía , Suturas , Resultado del Tratamiento
5.
J Plast Reconstr Aesthet Surg ; 72(12): 2027-2032, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31648959

RESUMEN

BACKGROUND: Tissue expanders can lead to bone deformity as well as bone resorption. Not all changes in the cranial bone can be completely normalised after tissue expander extraction. This study aimed to investigate the potential factors for persistent forehead deformities after tissue expansion. PATIENTS AND METHODS: Cases of forehead tissue expansion performed from 2011 to 2015 were retrospectively reviewed. Demographic and clinical data were collected. Two plastic surgeons (Y.Q. and C.Q.) evaluated changes in the forehead by comparing preoperative and most recent postoperative photographs. The Fisher exact, chi-square and Student t tests, and univariate and multivariate logistic regression analyses were performed in this study. RESULTS: Sixty-seven patients underwent forehead expanded flap reconstructions and continuous follow-ups were done in the outpatient service. The mean duration of the follow-ups after expander removal was 33.86 months. Overall, 28 (41.8%) patients had forehead changes. Age, sex, indications for tissue expansion and follow-up time were not associated with forehead changes. There were significant differences in the total injection volume and expansion period between patients with forehead changes (41.8%) and those without (58.2%). No significant negative correlation was found between the duration of pressure bandage usage post-operatively and the occurrence of forehead changes. CONCLUSIONS: Our recommendations for performing tissue expansion in the skull area are as follows: (1) always choose expanders with the largest base dimension; (2) perform tissue expansion as quickly as possible and (3) do not cause overexpansion. In addition, there was no proven benefit of using pressure bandages when skeletal changes occurred.


Asunto(s)
Frente/cirugía , Colgajos Quirúrgicos , Expansión de Tejido/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Asimetría Facial/etiología , Asimetría Facial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Dispositivos de Expansión Tisular/efectos adversos , Adulto Joven
6.
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
7.
Int J Pediatr Otorhinolaryngol ; 125: 107-112, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31280031

RESUMEN

OBJECTIVE: To investigate the clinical, imaging and pathological features of congenital infiltrating lipomatosis of the face (CILF) and to discuss whether it is a subtype of hemifacial hyperplasia (HH). METHODS: Sixteen patients diagnosed with CILF were included in this study. All patients had undergone panoramic radiography and spiral CT examinations. Thirteen patients received biopsy, surgery treatment and pathological examination. The clinical documentation and imaging data were retrospectively reviewed. RESULTS: The cheeks (14/16), parotid glands (12/16), tongues (9/16), masticatory muscles (8/16) and the lips (7/16) were the most frequently affected soft tissue organs. The maxilla (14/16), zygoma (13/16), mandible (13/16) were involved among the maxillofacial bones. Dental malformations included macrodontia (8/16), poor formation of the roots (7/16), accelerated tooth germ development or premature eruption of permanent teeth (7/16) and missing of the permanent teeth (4/16). All malformations were restricted to one side of the face and did not trespass the middle line. Pathologically, CILF was featured by the diffuse infiltration of redundant mature adipose tissue into the tissue of the affected organ. CONCLUSION: CILF is a congenital developmental facial malformation characterized by infiltration of nonencapsulated, mature adipose tissue, resulting in facial soft and hard tissue hypertrophy and dental malformations in hemifacial structures. CILF could be considered as a subtype of HH.


Asunto(s)
Cara/anomalías , Cara/cirugía , Asimetría Facial/congénito , Hiperplasia/etiología , Lipomatosis/congénito , Lipomatosis/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Cara/diagnóstico por imagen , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Asimetría Facial/cirugía , Femenino , Humanos , Hiperplasia/diagnóstico por imagen , Hiperplasia/cirugía , Lipomatosis/cirugía , Masculino , Radiografía Panorámica , Estudios Retrospectivos , Tomografía Computarizada Espiral , Anomalías Dentarias/diagnóstico por imagen , Anomalías Dentarias/etiología , Adulto Joven
8.
J Craniofac Surg ; 30(8): e707-e710, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31261325

RESUMEN

Unilateral condylar hyperplasia (UCH) is characterized by an overgrowth of the mandibular condyle responsible for a facial and dental asymmetry associated with temporomandibular joint function and maxillary growth consequences. The diagnosis is based on a body of clinical, radiological and histological arguments. A 38 years old woman with a reactivation of UCH after a latency period of 16 years following an orthognathic surgery performed for facial asymmetry normalization is presented. She was addressed to our department for a facial progressive asymmetry relapse and dental prosthetic consequences.The radiological images and the planar scintigraphy combined with single-photon emission computed tomography scans showed an active left unilateral condylar hyperplasia. A left proportional condylectomy was performed.The case presented highlights the possibility for the UCH to be reactivated after a long period of latency, leading to a relapse of the occlusal and facial disorders and so advocates the need for first condylectomy or at least a long-term follow-up if condylectomy is not performed as a first-line treatment.


Asunto(s)
Hiperplasia/diagnóstico por imagen , Cóndilo Mandibular/diagnóstico por imagen , Adulto , Asimetría Facial/cirugía , Femenino , Humanos , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos , Articulación Temporomandibular/diagnóstico por imagen
9.
Plast Reconstr Surg ; 144(2): 246e-251e, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31348355

RESUMEN

Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Asunto(s)
Asimetría Facial/cirugía , Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteotomía Le Fort/métodos , Medicina de Precisión/métodos , Impresión Tridimensional , Adulto , Estudios de Cohortes , Diseño Asistido por Computadora , Estética , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/terapia , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Cirugía Asistida por Computador/métodos , Taiwán , Resultado del Tratamiento , Adulto Joven
10.
J Craniofac Surg ; 30(7): 2144-2148, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31232991

RESUMEN

Facial asymmetry is a common maxillofacial deformity which requires surgery to recover the 3-dimensional relationship of bones. The computer-aided design and computer-aided manufacturing (CAD/CAM) has been developed and applied to improve orthognathic analysis and surgery design. How to accurately realize the preoperative design of orthognathic surgery with CAD/CAM occlusal splints during operation remains a big problem. In this study, 24 consecutive patients with facial asymmetry were recruited and assigned to 2 groups. For Group A, CAD/CAM was applied to designing and producing not only the occlusal splints, but also the drilling guiding templates and pre-bent titanium plates, and for Group B CAD/CAM was applied for occlusal splints only. Postoperative clinical examinations, symmetry evaluation through 3D cephalometric analysis, accuracy comparison using color distance maps and quantitative accuracy analysis were performed. Symmetry evaluation showed that patients of both groups achieved improved facial symmetry after surgery. The color distance maps and quantitative accuracy analysis together demonstrated significantly less difference found between virtual simulated surgery and postoperative CT scan data in Group A than in Group B. In conclusion, by navigation with the drilling guiding templates and pre-bent titanium plates, the facial symmetry for patients with facial asymmetry was successfully restored after orthognathic surgery, same as applying CAD/CAM occlusal splints only. However, the drilling guiding templates and pre-bent titanium plates would provide a more accurate performance according to preoperative simulation, especially for proximal mandibular segments.


Asunto(s)
Asimetría Facial/cirugía , Ferulas Oclusales , Procedimientos Quirúrgicos Ortognáticos/métodos , Titanio , Adolescente , Adulto , Cefalometría/métodos , Diseño Asistido por Computadora , Humanos , Mandíbula , Procedimientos Quirúrgicos Ortognáticos/instrumentación , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
11.
J Craniofac Surg ; 30(7): 2134-2137, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31205276

RESUMEN

Craniofacial microsomia (CFM) is a variable craniofacial malformation, related to the development of the structures originated from the first and second brachial arches, affecting skeletal tissue, soft tissue, and neuromuscular components. In the situation of subcutaneous tissue and chewing muscles hypoplasia, free tissue transfer is a treatment option. Dermal-fat graft allows easy modeling during surgery, volumetric gain and improvement of asymmetry. The aim of this study was to evaluate the facial contour and the percentage of symmetry after the use of dermal-fat graft in patients with CFM, who had already submitted to osteotomies, attended at the Associate Center for Cleft Lip and Palate (CAIF) during 2001 to 2018. For analysis, the authors selected 17 patients who fulfilled the above prerequisites. The symmetry study was done by the analysis of preoperative and postoperative photographs in the Image J software. Two standard points were used: nasal base and upper lip limit. On the nasal base, the preoperative analysis showed a hypoplastic side with a median of 93.00% of the normal side size, rising to 97.78% in the postoperative period. On the upper lip limit, the preoperative analysis showed a median of 87.80% and, in the postoperative period, 98.15%. Analysis of the interaction between the operative moments and the modified Pruzansky classification showed that there were no significant differences between grades. Long-term evaluation demonstrated that the use of a dermal-fat graft for correction of facial symmetry was effective and close to 100%, regardless of the degree of hypoplasia of the patient.


Asunto(s)
Cara/cirugía , Grasas , Síndrome de Goldenhar/cirugía , Adolescente , Adulto , Asimetría Facial/cirugía , Femenino , Humanos , Masculino , Adulto Joven
12.
Am J Orthod Dentofacial Orthop ; 155(5): 714-724, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31053287

RESUMEN

Surgical treatment of facial asymmetry usually involves 2-jaw orthognathic surgery. But when the size of the mandible differs a great deal between the right and left sides, as in hemimandibular hyperplasia, additional contouring surgery is required. A 20-year-old woman presented with facial asymmetry, showing marked mandibular hyperplasia of the right side. She was treated with the use of 2-jaw surgery with mandibular body osteotomy in conjunction with orthodontic intrusion. Good esthetic outcome and functional occlusion were achieved.


Asunto(s)
Asimetría Facial/cirugía , Mandíbula/anomalías , Osteotomía Mandibular , Técnicas de Movimiento Dental , Cefalometría , Oclusión Dental , Estética Dental , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Hiperplasia , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Radiografía Panorámica , Adulto Joven
13.
Orthod Fr ; 90(1): 75-100, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30994451

RESUMEN

INTRODUCTION: The aim of this retrospective cohort is to evaluate the amount of postsurgical correction of soft and hard tissues in patients with mandibular asymmetries and to compare the results with and without surgery of the lower mandibular contour (chin wing…). MATERIAL AND METHOD: Mandibular asymmetries cases of three surgeons were systematically included. The angles of deviation of the chin, bi-commissural, bi-gonic and occlusal were measured on face photography and radiography. A pre and post-surgical comparison was performed and the amount of correction was analyzed via the Wilcoxon statistical test. RESULTS: 51 patients (44 women and 7 men) were included. After surgery, the correction is significant for all measurements with an improvement of 44 to 60% depending on the measured angles. No patient is normalized but the small initial mandibular asymmetries are the closest to normal after surgery. The correction of the bi-commissural angle is controlled without being optimal (60% correction). The difficulty remains the horizontalization of the bi-gonial plan which is only corrected at 45%. Patients with mandibular margin surgery (chin wing…) showed the greatest improvement in bi-gonial (p = 0.0142) and occlusal (p = 0.0154) angles. CONCLUSION: If surgery allows a significant correction of facial dissymmetry, this is not complete. Surgical procedures on the lower edge of the mandible such as the chin wing could provide a better correction especially for bi-gonial and occlusal angles.


Asunto(s)
Mentón/cirugía , Asimetría Facial/cirugía , Mentoplastia/métodos , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Cefalometría , Estudios de Cohortes , Femenino , Humanos , Masculino , Maloclusión de Angle Clase III/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
14.
J Craniofac Surg ; 30(6): 1820-1824, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31033678

RESUMEN

OBJECTIVES: The purpose of this study was to compare the lip line cant (LLC) changes after 1 and 2-jaw surgery, and to evaluate the correlations of the craniofacial factors affecting LLC. METHODS: The study subjects were selected (LLC amount within 1.5-6.0°) from among the patients diagnosed with Class III malocclusion who underwent one (n = 20) or 2-jaw surgery (n = 20). Cone beam computed tomography images were obtained immediately before the operation (T1) and 6 months after the operation (T2). Preoperative and postoperative craniofacial measurements were obtained. RESULTS: The study subjects showed 3.12° LLC on average before undergoing 1-jaw surgery, and their LLC changed to 1.27° after the surgery. As for 2-jaw surgery, the subjects showed 3.38° LLC on average before the surgery and 0.98° after the surgery. LLC at pre-treatment may be more affected by a cant of the occlusal plane in the mandible than maxilla. In the comparison of the value of changes of LLC, the value of 2-jaw surgery was bigger than the value of 1-jaw surgery but the difference was statistically insignificant. LIMITATIONS: This study had a limitation in that the muscles were not considered. And the metal bracket or metal crown and bridge, however, can cause noise and blurring artifacts in CT, which can lead to a low resolution. And the limited number of the patients should be considered. CONCLUSIONS: In correlation analysis, both pre-surgery LLC and change of LLC have correlation with almost all the craniofacial measurement. Lip-line cant of patients with facial asymmetry has higher correlation with mandibular cant than with other cants. To improve the LLC, a surgical plan should be established to minimize the mandibular cant using the computer simulation as well as the maxillary cant.


Asunto(s)
Maloclusión de Angle Clase III/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Cefalometría , Tomografía Computarizada de Haz Cónico , Oclusión Dental , Asimetría Facial/cirugía , Femenino , Humanos , Labio/anatomía & histología , Masculino , Maloclusión de Angle Clase III/cirugía , Mandíbula/cirugía , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos
15.
Plast Reconstr Surg ; 143(5): 1447-1455, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31033827

RESUMEN

BACKGROUND: The successful correction of craniofacial contour deformities remains a major challenge in plastic surgery. This article reviews important concepts and strategies for craniofacial fat grafting and presents a SOBRAPAR Hospital algorithm focused on achieving craniofacial contour symmetry as early as possible without compromising function. METHODS: Principle-based methods (i.e., anatomical facial fat compartments, fluid accommodation model, multistage site-specific craniofacial fat grafting, and structural fat-grafting technique) were itemized into an algorithm to aid in planning and selecting the best surgical approach (i.e., bone and/or soft tissue procedures) in order to obtain craniofacial contour symmetry. RESULTS: The treatment plan and choice of surgical technique implemented to address bone and/or or soft tissue deformities were determined by specific diagnosis, patient age at presentation, and functional status. Bony reconstruction in skeletally immature patients is reserved solely for those patients with functional issues. CONCLUSION: By adopting principle-based methods and fat compartment theory, we are able to achieve craniofacial contour symmetry and aesthetically pleasing outcomes without compromising function.


Asunto(s)
Tejido Adiposo/trasplante , Anomalías Craneofaciales/complicaciones , Asimetría Facial/cirugía , Procedimientos Ortopédicos/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Factores de Edad , Niño , Preescolar , Vías Clínicas , Estética , Asimetría Facial/etiología , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Resultado del Tratamiento , Adulto Joven
16.
Plast Reconstr Surg ; 143(5): 1467-1476, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31033829

RESUMEN

BACKGROUND: Craniofacial microsomia is characterized by an asymmetric hypoplasia of derivatives of the first and second pharyngeal arch, leading to a variety of phenotypic presentations. Studies on surgical correction of patients with craniofacial microsomia have small cohorts, leaving controversial opinions on the optimal treatment modality, the indication for surgery, and the optimal timing of surgery. The purpose of this study was to evaluate the types of, timing of, and total number of surgical corrections performed and the number of surgical procedures in correlation to the severity of the phenotype. METHODS: A retrospective chart study was conducted including patients diagnosed with craniofacial microsomia from three large craniofacial units. Demographic, radiographic, and clinical information was obtained, including type and number of surgical procedures and age at the time of surgery. RESULTS: A total of 565 patients were included. In total, 443 (78.4 percent) of all patients underwent some form of surgery during their life, varying from skin tag removal to major craniofacial operations. The number of surgical interventions was higher with increasing severity of phenotype, bilateral presentation, and a younger age at the first intervention. CONCLUSIONS: Multiple surgical corrections are frequently seen in patients with a more severe or bilateral presentation. Furthermore, those who are treated earlier in life for correction of asymmetry of the mandible will undergo significantly more surgical procedures to correct the asymmetry later on, independent of the Pruzansky-Kaban type mandible. A prospective international multicenter study is designed with a uniform registration and outcome measurement tool to identify the optimal treatment strategy.


Asunto(s)
Asimetría Facial/cirugía , Síndrome de Goldenhar/cirugía , Procedimientos Ortopédicos/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adolescente , Factores de Edad , Boston , Niño , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Femenino , Síndrome de Goldenhar/complicaciones , Síndrome de Goldenhar/diagnóstico por imagen , Humanos , Cooperación Internacional , Londres , Masculino , Mandíbula/anomalías , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Países Bajos , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Tiempo de Tratamiento , Resultado del Tratamiento
17.
J Craniofac Surg ; 30(3): 846-850, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30817522

RESUMEN

Fat grafting has become a well-accepted surgical modality to correct soft tissue facial defects and asymmetries with overall good results. Several techniques have been reported over the last few years to assist in improving accurate evaluation of facial defects and in the preoperative planning of the reconstruction. Such techniques include among others, computer tomography, three-dimensional (3D) photogrammetry, high resolution ultrasound, and 3D laser scanning. There are advantages and disadvantages for each technique.With the rapid advance of 3D technologies that have become readily available to clinicians, new clinical applications continually emerge to guide and facilitate reconstructive procedures. The authors explored the possibility of fabricating a 3D printed surgical guide to define volume differences for soft tissue reconstruction in patients with facial asymmetry. The model was developed through the authors' virtual surgical simulation and planning system that consists of computer-assisted design (CAD) and 3D printing (3DP).Three-dimensional volumetric scans of patients' faces were analyzed with computer-aided design to quantify areas of facial asymmetry. Surgical guides with containers defining volumetric differences were fabricated using 3D printing to identify and quantify areas of soft tissue deficiency. The 3D printed patient-specific, guides were sterilized and used by the surgeon intraoperatively to accurately mark the areas of soft deficiency. Thus, facial symmetry was achieved by fat grafting the predetermined volume differences defined in the surgical guides. A postop mask was used by the surgeon at the end of the procedure and during follow-up clinic visit to verify and evaluate accurate fat grafting placement as well as to determine areas where to add volume if needed.This paper details the rational for the authors' approach, outlines the technical planning and fabrication process of these patient-specific custom surgical guides with quantified volumetric containers and their intraoperative use by the surgeon. Despite the authors' limited experience we conclude that the authors' technique offer surgeons a precise means for accurate volumetric reconstruction of facial asymmetry.


Asunto(s)
Asimetría Facial/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cirugía Asistida por Computador/métodos , Tejido Adiposo/trasplante , Adolescente , Diseño Asistido por Computadora , Femenino , Humanos , Imagenología Tridimensional , Máscaras , Impresión Tridimensional , Tomografía Computarizada por Rayos X , Adulto Joven
18.
BMJ Case Rep ; 12(2)2019 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-30737324

RESUMEN

Unilateral condylar hyperplasia is characterised by slow progressive growth of the different parts of mandible, the aetiology of which is still unclear. It is a self-limiting condition mostly seen between the age of 11-30 years causing facial asymmetry and its progression ceases after a certain time. In literature until now very few cases have been reported and every case that is being reported adds to its features or the aetiology. Previously, it has been classified into two types that is, hemimandibular hyperplasia and hemimandibular elongation. Here, we report a similar case with a few features distinct from those reported earlier.


Asunto(s)
Asimetría Facial/cirugía , Hiperplasia/diagnóstico por imagen , Maloclusión/patología , Mandíbula/anomalías , Cóndilo Mandibular/patología , Osteotomía/métodos , Adulto , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Mandíbula/crecimiento & desarrollo , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Orales/métodos , Resultado del Tratamiento
20.
J Craniofac Surg ; 30(2): 483-488, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30688816

RESUMEN

Orbital asymmetry in unicoronal synostosis impacts craniofacial appearance and can potentiate functional visual disturbances, such as strabismus. Surgical treatment aims to normalize overall cranial morphology, including that of the orbits. The purpose of this study was to compare postoperative changes in orbital asymmetry following 2 common procedures.Preoperative and 1-year postoperative computed tomography scans for patients with isolated, nonsyndromic unicoronal synostosis treated from 2007 to 2012, at 2 academic institutions were analyzed. Only patients treated by endoscopic suturectomy and postoperative helmeting or bilateral fronto-orbital advancement were included. Orbital index, depth, and volume asymmetry were determined for each patient both pre- and 1-year postoperatively. Student's t-tests were used to compare pre- and postoperative asymmetries within each treatment group. Regression analyses were used to examine postoperative change in asymmetry between treatment groups.Scans from 12 patients treated by fronto-orbital advancement and 23 treated by endoscopic suturectomy were analyzed. Differences between synostotic and nonsynostotic orbital index, depth, and volume were statistically significant both pre- and postoperatively. Statistically significant postoperative improvements in asymmetry were observed for orbital index, depth, and volume following suturectomy. Regression analysis indicated that the amount of pre- to postoperative change in all measures of asymmetry did not depend on surgical technique. Residual asymmetry following both procedures was apparent at 1 year postoperatively.Orbital asymmetry is improved, but not resolved following both fronto-orbital advancement and endoscopic suturectomy. Degree of improvement in symmetry is independent of surgical technique used.


Asunto(s)
Craneosinostosis/cirugía , Asimetría Facial/cirugía , Órbita/anomalías , Procedimientos Ortopédicos/métodos , Craneosinostosis/diagnóstico por imagen , Craneosinostosis/patología , Endoscopía , Asimetría Facial/congénito , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Lactante , Masculino , Órbita/diagnóstico por imagen , Órbita/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA