Comprehensive consideration and design for treatment of square face.

PURPOSE: From an East Asian traditional esthetic viewpoint, a soft facial appearance seems to be more attractive. A prominent mandibular angle, a high zygomatic bone, and an inharmonious chin strongly lessen the attributes of femininity. Attention should be paid to the zygomatic projection and square mandible from the frontal view and the gonial angle and mental region configuration from the lateral view to obtain a slender oval face (melon seed face). PATIENTS AND METHODS: From January 2005 through December 2010, 47 patients underwent a combination of 4 operative techniques to reshape a square face: L-shaped osteotomy, V-line osteotomy, mandibular outer cortex splitting ostectomy, and sliding genioplasty. RESULTS: Outcomes in and feedback information from patients showed that these methods made the square face look more harmonious, with significant improvement of the middle and lower facial contours. CONCLUSIONS: Asians with a square face have different combinations of facial features; thus, surgeries should be customized and designed comprehensively to achieve optimal results.

How to achieve a balanced and delicate lower third of the face in Orientals by mandibular contouring.

INTRODUCTION: For East Asians, correction of square jaw has become one of the commonly performed procedures in aesthetic surgery. While reviewing unsatisfactory cases of mandibular reduction, the authors discovered that failure was largely due to surgeons generally focussing too much on treatment of the posterior part of the mandible, and ignoring the aesthetic significance of the harmonious and smooth overall curve from the anterior mandible to the inferior margin of the mandible. Thus, our group proposes that a coordinated, balanced and smooth jaw line is considered a key factor in Oriental mandibular contouring. PATIENTS AND METHODS: A total of 128 patients accepted jaw line reshaping by 'V-line' ostectomy, mandibular outer cortex split ostectomy, narrowing and/or sliding genioplasty and porous polyethylene implantation to achieve the desired cosmetic effects. RESULTS: All patients obtained satisfactory cosmetic results, and their square jaw was corrected. After the operation, a natural, harmonised and balanced jaw line was achieved. Lower third of the facial contour was significantly improved. CONCLUSION: Based on different facial features of square jaw deformity, a variety of plastic surgical methods for mandibular contouring were integrated and applied to achieve a balanced and delicate jaw line.

Denervation impairs bone regeneration during distraction osteogenesis in rabbit tibia lengthening.

BACKGROUND AND PURPOSES: The nervous system plays an important role in bone metabolism. However, the effect of denervation on bone formation during distraction osteogenesis (DO) remains unclear. We studied neural influence on bone regeneration during DO in a rabbit model. METHODS: 24 New Zealand male white rabbits underwent left tibial osteodistraction. Before distraction, the animals were randomly divided into group R (resected left sciatic nerve) and group I (intact left sciatic nerve). 8 weeks after completion of distraction, the animals were killed and the lengthened tibias were harvested for radiography, micro-CT, histological evaluation, and mechanical testing. RESULTS: New regenerated bone was present in the distraction gaps of all animals at the end of the study, as revealed by radiography, micro-CT, and histology. However, less new bone formation and a lower degree of mineralization were observed in group R. The mechanical strength of the distraction gap in group I was 1.3-fold greater than that in group R when measured using the 3-point bending test. INTERPRETATION: The results suggest that the nervous system plays an essential role during DO: the denervation appears to have an inhibitory effect on bone formation.

CAD/CAM and rapid prototyped titanium for reconstruction of ramus defect and condylar fracture caused by mandibular reduction.

Fracture or defect of the mandible is a serious complication of mandibular angleplasty, and precise reconstruction for such defect is still a huge challenge. This case report provides a new method based on CAD/CAM and rapid prototyped titanium for individual design, fabrication, and implantation of a mandibular ramus and angle. A 25-year-old woman with a square-shaped face, who had undergone mandibular outer cortex split ostectomy (MOCSO) 3 months earlier, was afflicted by a series of symptoms: asymmetric face, collapse of the right face, masticatory problems, deviation during mouth opening, malocclusion, and TMJ clicks. These symptoms were caused by unintentional removal of the fractured ramus during MOCSO. By means of CT scan data, rapid prototyping, reverse engineering, 3D display, and CAD/CAM, the individualized titanium implant was designed and fabricated. The 3D demo system of operative scheme demonstrated the operative procedure, and determined the position of the implant so as to obtain a perfect fit. Postoperatively, the patient regained satisfactory morphologic symmetry, facial appearance, occlusion, and TMJ functions.

Correction of midface hypoplasia using a novel trapezoidal osteotomy.

BACKGROUND: Currently, investigating an optimal method to deal with midface hypoplasia has become a significant issue in the field of facial aesthetic surgery. Traditional ways to address this problem primarily include segmental osteotomies and using autogenous bone or cartilage grafts or synthetic implants. For the patients with paranasal hypoplasia but without malocclusion, autogenous bone grafts or implants are recommended. However, some of these patients have a flattened nose and protrusive malar, especially in the Eastern Asian; the nose will seem more flattened after augmentation the paranasal area. Hence, osteotomy is necessary in these patients to bring the flattened nose forward to get a more satisfying contour of the midface. METHODS: We propose a novel osteotomy through the application of model surgery to solve the problem of midface hypoplasia combined with flattened nose but without malocclusion. When compared with other techniques, this novel method not only allows the augmentation to be performed on a broader scale composed of different segments of the midface skeleton, but also results in a lower surgical risk and maintenance of the stability of occlusion. RESULTS: This novel osteotomy can bring the premaxilla in combination with the nasal bone forward to solve the problem of midface hypoplasia combined with flattened nose in patients with normal occlusion. CONCLUSIONS: Through simultaneous augmentation of the different segments of the midface through this novel osteotomy, a more pleasing contour of the midface in all 3 dimensions can be achieved.

Total or partial inferior border ostectomy for mandibular contouring: indications and outcomes.

Among the East Asian population, a long or square face produces a characteristic coarse and masculine appearance and is therefore considered undesirable and unattractive. Because of this many Orientals seek to achieve a harmonious contour of their face by undergoing various cosmetic surgical procedures. Mandibular contouring for a long or asymmetrical face with/without square jaw is rarely reported in the literature and the objective of this study was to investigate the effectiveness of total or partial inferior border ostectomy for mandibular contouring and to discuss its indications. From July 2005 to November 2009, 74 patients in this study received mandibular contouring by total or partial inferior border ostectomy procedure to correct a disharmonious facial contour. Postoperatively the appearance of all 74 cases showed that the length of the lower 3rd of the face and the width of the mandible were decreased effectively, and the mandibular contour was improved. The final aesthetic outcomes were satisfactory for both the surgeons and the patients. The results suggest that facial contour could be improved by using total or partial inferior border ostectomy of the mandible thus achieving a harmonious facial outline based on East Asian aesthetics.

Surgical designs and techniques for mandibular contouring based on categorisation of square face with low gonial angle in orientals.

INTRODUCTION: In East Asian population, a square face is considered unappealing as it imparts a coarse and masculine look. Therefore, Oriental women prefer to have an ovoid and slender facial contour, which is thought to be more feminine and attractive. Nowadays, mandibular contouring surgery has become a commonly performed procedure. Clinical data show that majority of patients who have severe form are characterised by a definite square-shaped face with low gonial angle. A square face is usually visualised in frontal view but the lateral view provides additional information regarding gonial angle, mandibular plane steepness, chin deficiency and more importantly, length of the ramus. These factors are the key points for a precise categorisation, design, selection of surgical methods and choosing the ostectomy line for contouring on a square face with low angle. PATIENTS AND METHODS: From 2005 to 2009, 94 women were diagnosed as square face with low angle. Three types of surgical design based on procedures such as mandibular 'V-Line' ostectomy, mandibular outer cortex split ostectomy, sliding genioplasty and inlay bone graft in various combinations were constructed, depending upon the presenting facial features. RESULTS: Precise categorisation, designs and techniques resulted in higher satisfaction as these procedures provided an overall narrowing and harmonising effect on the lower facial contour postoperatively. CONCLUSION: Patients with square face and low gonial angle come with multitude of features so that design and technique applied should be tailored to each individual to achieve perfection.

Evaluation of hybrid porous biomimetic nano-hydroxyapatite/polyamide 6 and bone marrow-derived stem cell construct in repair of calvarial critical size defect.

Nano-hydroxyapatite/polyamide 6 (n-HA/PA6) composite scaffolds were prepared by a combined method of phase separation and particle leaching processing technique. The porous matrices were seeded with allogenic bone marrow-derived stem cells (BMSCs) and implanted in the critical-size calvarial defect (8-mm diameter) in rats. The adhesion, proliferation, and differentiation of BMSCs were demonstrated by (3-{4,5-dimethylthiazol-2yl}-2,5-diphenyl-2H-tetrazoliumbromide) assay, immunohistochemical staining, and scanning electron microscopy in vitro. Cell survival was tracked via fluorescent labeling in vivo. The regeneration process was evaluated by several techniques at 4, 8, and 16 weeks after implantation. According to the results, the porous n-HA/PA6 scaffolds are biocompatible and have no negative effects on the BMSCs in vitro. Nano-hydroxyapatite/polyamide 6 composite combined with BMSCs exhibited good biocompatibility and osteoconductivity and enhanced osteogenesis at the initial stage after implantation. The results demonstrated that porous n-HA/PA6 scaffold is a potential matrix for bone tissue engineering, and using BMSCs as seed cells on porous n-HA/PA6 might be an alternative procedure in repair of large defect due to enhanced osteogenesis and osteointegration.

Contouring of a square jaw on a short face by narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy in orientals.

BACKGROUND: A square face is considered unattractive in Orientals; thus, it has become a frequently encountered reason for patients undergoing face contouring surgery. While reviewing the unsatisfactory cases of mandibular reduction, the authors discovered that some failed cases were related to a square jaw on a short face. The conventional procedures fix only the posterior region of the mandible, resulting in increased prominence of the stunted or square chin and short face. Thus, the authors applied a narrowing and sliding genioplasty procedure combined with a mandibular outer cortex ostectomy technique to reshape a wide, weak chin, and a square jaw on a short lower facial contour into a slender and attractive oval face. METHODS: From July of 2005 to October of 2009, there were a total of 57 patients in this study who underwent a narrowing and sliding genioplasty combined with a mandibular outer cortex ostectomy procedure to correct a square jaw on a short face. RESULTS: The postoperative appearance of all 57 cases showed that the lower face had narrowed and had become softer, slender, and oval, with a slick mental region. CONCLUSION: Narrowing and sliding genioplasty combined with a mandibular outer cortex ostectomy procedure could efficiently adjust the shape and position of the chin to obtain a good proportion of the lower face and change a square, short face to a slender, oval one in a single operation in accordance with fashionable aesthetics in Orientals.

Changes in quality of life after orthognathic surgery: a comparison based on the involvement of the occlusion.

OBJECTIVES: The aims of this study were to investigate the impact of dentofacial deformities on quality of life in Chinese patients and to make a comparison between facial deformities that do and do not involve the occlusion. STUDY DESIGN: Consecutive patients with dentofacial deformities requiring surgical correction were divided into 2 groups. Group A represented those who had undergone presurgical orthodontic treatment, and group B represented patients with square faces or prominent zygoma. All subjects were assessed by the 36-item Short-Form Health Survey (SF-36) and the 22-item Orthognathic Quality of Life Questionnaire (OQLQ-22) during 2 time periods: preoperatively and 6-8 months postoperatively. RESULTS: The SF-36 revealed that there was significant difference in role physical and bodily pain (P < .05) preoperatively between the 2 groups, whereas postoperatively the difference was not significant. Preoperatively, there was significant difference in oral function and facial esthetics components of OQLQ (P < .001), whereas postoperatively only the oral function domain showed significant difference. CONCLUSIONS: Orthognathic surgery had a positive impact on patients' quality of life regardless of the type of deformity. OQLQ showed better discerning ability and was able to point out the subtle differences between the 2 groups.

Correction of zygoma and zygomatic arch protrusion in East Asian individuals.

OBJECTIVE: Prominent zygoma is commonly seen in the East Asian population with the clinical characteristics of anteriorly and/or laterally projected zygoma and zygomatic arch resulting in an increased midfacial width. The esthetic surgical modification of zygoma is one of the major aspects of facial-contouring surgery in certain parts of the world. This article aims to evaluate the effectiveness of various surgical methods for reducing the prominent zygoma so as to obtain a harmonious and natural facial contour. METHODS: Surgical approaches, such as zygomatic complex shaving, I-shaped osteotomy, L-shaped osteotomy, and C-shaped osteotomy were used according to the clinical characteristics of zygoma and zygomatic arch protrusion. The corrective effectiveness was then evaluated through cephalometric radiographs, 3D-CT, and pre- and postsurgical standard facial photographs. RESULTS: The zygoma and zygomatic arch protrusion was effectively corrected resulting in improved facial contours in all cases postoperatively. The postoperative period was uneventful except for the slight limitation in mouth opening, which recovered fully after mouth-opening exercises. Serious complications, such as facial nerve injury, were not witnessed in our study. CONCLUSIONS: Malar reduction is an effective and a safe method for the treatment of prominent zygoma. The selection of surgical procedure should be based on different presenting characteristics of zygoma and zygomatic arch protrusion. The correction of prominent zygoma should be designed well, performed precisely, and observed carefully to avoid severe complications so as to achieve a harmonious facial contour.

Computer-aided design and manufacturing and rapid prototyped nanoscale hydroxyapatite/polyamide (n-HA/PA) construction for condylar defect caused by mandibular angle ostectomy.

The fracture or defect of the mandibular condyle is one of the serious complications during angle-reduction ostectomy. Reconstruction of such defects also is a daunting task. The case report describes a method based on computer-aided design/computer-aided manufacturing (CAD/CAM) and rapid prototyping nanoscale hydroxyapatite/polyamide (n-HA/PA) for individual design, fabrication, and implantation of a mandibular condyle. A 27-year-old woman with a square-shaped face who had previously undergone mandibular angle reduction reported with malocclusion, deviated mouth, collapse of the right side of the face, and masticatory problems. The reason for the problems was the unintended removal of the condyle during the ostectomy procedure. Using computed tomography (CT) data, a biomimetic n-HA/PA scaffold, and CAD/CAM for rapid prototyping by three-dimensional (3D) printing, a perfect-fitting condylar implant was fabricated. A surgical guide system also was developed to reproduce the procedures accurately so a perfect fit could be obtained during surgery. The patient ultimately regained reasonable jaw contour and appearance, as well as appreciable temporomandibular joint (TMJ) function.

Ectopic osteochondral formation of biomimetic porous PVA-n-HA/PA6 bilayered scaffold and BMSCs construct in rabbit.

In this work, the novel poly vinyl alcohol/gelatin-nano-hydroxyapatite/polyamide6 (PVA-n-HA/PA6) bilayered scaffold with biomimetic properties for articular cartilage and subchondral bone is developed. Furthermore, when these osteochondral scaffolds were seeded with induced bone mesenchymal stem cells (BMSCs) and implanted at ectopic sites, showed the potential for an engineered cartilage tissue and the corresponding subchondral bone. BMSCs were expanded in vitro and induced to chondrogenic or osteogenic potential by culturing in suitable media for 14 days. Subsequently, these induced cells were seeded into PVA-n-HA/PA6 separately, and the constructs were implanted into the rabbit muscle pouch for upto 12 weeks. Ectopic neocartilage formation in the PVA layer and reconstitution of the subchondral bone which remained confined within the n-HA/PA6 layer with the alteration of the cellular phenotype were identified with Masson's trichrome stain. Simultaneously, the RT-PCR results confirmed the expression of specific extracellular matrix (ECM) markers for cartilaginous tissue, such as collagen type II (Col-II), or alternatively, markers for osteoid tissue, such as collagen type I (Col-I) at the corresponding layers. During ectopic implantation, the underlying subchondral bone layer was completely integrated with the cartilage layer. The result from the ectopic osteochondral scaffolds implantation suggests that PVA-n-HA/PA6 with induced BMSCs is a possible substitute with potential in cartilage repair strategies.

Clinical observations of correction of square jaw in East Asian individuals.

OBJECTIVE: A square face along with a variety of facial features is considered to be unappealing in the East Asian population. Thus, the objective of this study was to assess the facial features and the various operative techniques available for surgical correction of a square jaw via the intraoral approach. STUDY DESIGN: All surgical procedures were performed via the intraoral approach. Surgical approaches such as curved mandibular ostectomy, outer cortex splitting ostectomy, "V-Line" ostectomy, and modified genioplasty were performed according to the different types of facial characteristics. All the patients had standard frontal and lateral cephalometric radiographs and panoramic radiographs, and were photographed preoperatively and postoperatively to assess their facial contour. RESULTS: The width of the lower face caused by prominence of the mandibular angle was effectively corrected, resulting in improved facial contours. Limitation of mouth opening was seen immediately postsurgically but returned to normal following a period of mouth-opening exercises. Serious complications, such as facial nerve injury or fracture, were not witnessed in our study. CONCLUSION: Mandibuloplasty is an effective and a safe method for the treatment of a prominent mandibular angle. The selection of surgery should be based on the type of square jaw.