Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty.

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Surgical and histological evidence of case reports showing Schwannomas in the nasal area.

INTRODUCTION AND IMPORTANCE: Schwannomas are benign neurogenic neoplasms with an uncommon involvement of the nasal cavity and paranasal sinus, which usually appear as a painless formation. We report two cases of nasal schwannoma that was successfully treated by surgical excision with satisfactory functional outcomes. The aim of this study is to discuss the clinical assessment and imaging, (CT, MRI) differential diagnosis, histological examination, surgical approaches of this rarely encountered neoplasm in the sinus-nasal area. CASE PRESENTATION: Case 1: a 53 years-old Caucasian male, hospitalized in the ENT Department with a 5-month progressive history of right nasal obstruction without epistaxis was diagnosed as a Schwannoma following clinical, histology and ENT endoscopy examination. Case 2: a 45 years-old Caucasian male with asymptomatic swelling arising 4 months before in the nasal tip area with progressive nasal deformity, diagnosed as a schwannoma and analyzed with MRI. CLINICAL DISCUSSION: Case 1: The patient had an uneventful post-operative course and a follow-up examination at 36 months showed no recurrence of the neoplasm with satisfactory functional result. Case 2: The patient had an uneventful post-operative course and a follow-up examination at 5 years showed no recurrence of the neoplasm and satisfactory aesthetic result. CONCLUSIONS: Schwannomas arising from sinonasal area are extremely rare, painless and with slow-growing evolution. The surgical option and histologic analysis are mandatory for a correct diagnosis.

Septal extension graft in "closed" revision rhinoplasty: A simplified technique.

BACKGROUND: The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in "closed" rhinoplasty can be discouraging. OBJECTIVE: To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure. METHODS: Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient. RESULTS: An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded. CONCLUSION: The "endonasal" approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.

Chin Microgenia: A Clinical Comparative Study.

BACKGROUND: The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon's decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers. OBJECTIVE: The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases. METHODS: A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up. RESULTS: The analysis of the results based on the entity of the chin's sagittal defect, the chin soft-tissue thickness, the patient's age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers. CONCLUSIONS: Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical treatment of unilateral condylar hyperplasia with piezosurgery.

INTRODUCTION: Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in association with orthognathic surgery can improve the occlusion and the facial aesthetics. MATERIALS AND METHODS: Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation. RESULTS: The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth. CONCLUSIONS: High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy.

Unilateral masseter muscle hypertrophy: morphofunctional analysis of the relapse after treatment with botulinum toxin.

This is a case of unilateral masseter muscle hypertrophy (MMH) treated with botulinum toxin (NHAI-normalised hemi-facial asymmetry index improvement from 5.48 to 3.04). After 19 months the treatment was repeated because of hypertrophy relapse (NHAI increase up to 6.82). The volume variations in the masseter area were monitored during 25 months using a laser scanner to compute facial volume. In order to relate the cause of hypertrophy and relapse to the presence of parafunctional activities, a nocturnal electromyography (EMG) study was conducted with positive results (nocturnal parafunctions of patients 4074.99 microV to be compared with a control group value of 1644.63 microV). The lack of the left inferior molars and the consequent right occlusal support seemed to justify the hypertrophy of right masseter (MMRight-POC [percent overlapping coefficient] 91.9%). However, the prosthetic rehabilitation did not prevent relapse in the same muscle. The EMG analysis of both the muscular activation (MMRight-POC 66.0% after relapse) and inhibition activity in Maximum Voluntary Clench (MVC) resulted in contradictory conclusions. At present, the available knowledge regarding MMH physiopathology is very limited and does not support a therapeutic rationale for relapse prevention.

A 3-Dimensional Facial Morpho-Dynamic Database in the development of a prediction model in orthognathic surgery.

BACKGROUND: Current methodologies in the prevision of post-surgical features of the face in orthognathic surgery are mainly 2-D. An improvement is certainly given by the introduction of CT, but its acceptance is controversial due to its high biological cost. As an alternative, in this study an effective procedure for the construction of a 3-D textured digital model of the face and dental arches of patients with dentofacial malformations using a 3-D laser scanner at no biological cost is presented. METHODS: A 3-D Laser scanner Konica-Minolta VIVID 910 is used to obtain multiple scans from different perspectives of the face of patients with dentofacial malocclusions requiring orthognathic surgery. These multiple views are then recombined, integrating also the maxillary and mandibular arch plaster casts, to obtain the 3-D textured model of the face and occlusion with minimal error. RESULTS: A viable methodology was identified for the face and occlusal modeling of orthognathic patients and validated in a test case, confirming its effectiveness: the 3-D model created accurately describes the actual features of the patient's face; the proposed methodology can be easily applied in the clinical routine to accurately record the steps of the surgical treatment and to perform accurate anthropometric analyses of the facial morphology, and thus constitute the necessary database for the development of previsional tools in orthognathic surgery. CONCLUSIONS: The proposed method is effective in recording all the morphological facial features of patients with dentofacial malformations, to develop a facial modification database and tools for virtual surgery.