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1.
Am J Ophthalmol ; 213: 57-61, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31953059

RESUMO

PURPOSE: We evaluated the relative effectiveness of combined recession-resection of vertical rectus muscles versus superior rectus recession with inferior oblique weakening for patients who underwent surgical correction of chin-down abnormal head position (AHP) associated with infantile nystagmus syndrome (INS). DESIGN: Retrospective interventional case series. METHODS: This is a review of 22 patients who underwent surgical correction of chin-down vertical AHP associated with INS at an academic institution. The primary outcome was collapse of AHP. Unfavorable outcomes included repeat surgery and induced strabismus, in addition to failure of collapse of AHP. RESULTS: Twenty-two patients had chin-down AHP. Recession-resection (bilateral superior rectus recession 6-9 mm; bilateral inferior rectus resection 5-9 mm) was performed in 11 cases; weakening of both elevators (bilateral superior rectus recession 5-8 mm, bilateral inferior oblique recession or myectomy) occurred in 11 cases. Unfavorable outcome rates were 64% (7/11) compared with 18% (2/11), respectively (P = .03). Reoperation was performed for 6 of 22 patients. Five patients were from the recession-resection group, namely 3 for induced V-pattern esotropia, 1 for alternating esotropia, and 1 to correct recurrent AHP. The last of the 6 who required reoperation was in the elevator weakening group, and required correction of a recurrent AHP (P = .06). CONCLUSIONS: While recession-resection of the vertical recti and weakening of both elevators each produce acceptable collapse of chin-down AHP, the former frequently induces a V-pattern esotropia requiring reoperation.


Assuntos
Cabeça/fisiologia , Nistagmo Congênito/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Postura/fisiologia , Adolescente , Criança , Pré-Escolar , Queixo/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Nistagmo Congênito/fisiopatologia , Reoperação , Estudos Retrospectivos , Visão Binocular/fisiologia , Acuidade Visual/fisiologia
2.
J Craniofac Surg ; 31(2): 564-567, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977711

RESUMO

BACKGROUND: Since 2012, the authors have adopted the medial subcoronoid process bone interpositional grafting in OGS and genioplasty procedures. The purpose of this study was to present the technical details and clinical outcomes of this alternative bone interpositional grafting for LeFort I and chin osteotomies. METHODS: Consecutive patients (n = 50) who underwent single-splint bimaxillary OGS with or without genioplasty and received medial subcoronoid bone interpositional grafting were included. Standardized facial and intraoral photographs at early and late postoperative periods (12.2 ±â€Š3.3 and 44.8 ±â€Š8.4 months postsurgery, respectively) were blindly rated to assess facial symmetry, chin, and occlusion status based on qualitative rating scales. Complication and reoperation rates were also reviewed. RESULTS: The medial subcoronoid bone interpositional grafts were adopted to stabilize different LeFort I maxillary movement types or lengthening/advancing genioplasty (36 and 14 patients, respectively). Overall, the early facial symmetry, chin, and occlusion status were maintained at late evolutions. None of the patients had donor-site or bone graft-related complications (i.e., bad split, undesired mandible fracture, infection, fibrous union, nonunion, and/or permanent neurosensory deficit) or revisionary surgery during follow-up. CONCLUSION: The medial subcoronoid process bone grafting was a feasible alternative for bone interpositional defects of LeFort I and chin osteotomies with no significant morbidity and avoiding secondary donor sites.


Assuntos
Transplante Ósseo , Queixo/cirurgia , Oclusão Dentária , Mentoplastia/instrumentação , Mentoplastia/métodos , Humanos , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/instrumentação , Procedimentos Cirúrgicos Ortognáticos/métodos
3.
J Craniofac Surg ; 31(1): 303-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31634314

RESUMO

The aim of this study was to investigate whether it is possible to pull the platysma effectively in the medial or lateral direction (medial platysmaplasty and lateral platysmaplasty) and to explore the anatomical basis of those findings.Six hemifaces from 3 fresh cadavers were dissected. After skin removal, the platysma was pulled upward and in the medial or lateral direction with the ulnar side of the palm. Its mobility was checked. In 2 volunteers, using wooden bar, the skin overlying platysma was pulled in superomedial and superolateral direction.The platysma ran diagonally from the acromio-deltoid region to the perioral and submental area. In all hemifaces, the platysma was attached to the mandible along its course. The platysma inserted into the mandibular body. At its medial portion (approximately halfway medially from the mentum to the angle; 4-5 cm), the attachment was so firm that it could not be moved horizontally. The posterolateral portion of the platysma was indirectly attached to the mandible and movable. In cadaver, platysma did not move much when it was pulled in the medial direction. In the lateral direction, however, platysma did move well. In living body, when skin overlying platysma was pulled in superomedial direction and superolateral direction, 3 points marked on mandibular border moved about 1.5-2.0 cm and 2.0-2.5 cm respectively.It is thought that medial platysmaplasty can correct anterior neck deformities and redistribute neck skin mainly in the submental area, while that lateral platysmaplasty can pull the cheek skin in superolateral direction.


Assuntos
Ritidoplastia , Adulto , Cadáver , Queixo/cirurgia , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Pescoço/cirurgia
4.
J Craniofac Surg ; 31(2): e116-e119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31842085

RESUMO

Ameloblastoma is the second most common odontogenic tumor arising in the maxillary bones. The WHO classified ameloblastoma in: solid/multicystic (SMA); unicystic; peripheral and desmoplastic. A conservative or radical approach may be performed for SMA treatment to achieve total excision of the lesion.In this case report, a 47-year-old woman, presented a deformation of the left mandibular region and paresthesia of the left hemi-labium, at the ortopanoramic x-ray (OPT) a multilocular osteolytic lesion and the rhizalysis of dental elements 3.7, 3.6, 3.5, 3.4 and the inclusion of 3.8 was appreciated; the CT exam showed erosion of the mandibular canal roof and of the vestibular cortex in the mental nerve region. The patient was subjected to the extraction of the elements in rhizalysis and of 3.8 and subsequently to the enucleation of the lesion followed by an extensive peripheral ostectomy performed with a piezoelectric device. The patient underwent to OPT and CT examinations follow-up and after 5 years was subjected to implant surgery, at the same time of the implant's placement, bone biopsies were performed using core drills in order to evaluate the bone histologically. The patient showed complete clinical and radiographic healing; the histological examination demonstrates the formation of lamellar bone.


Assuntos
Ameloblastoma/cirurgia , Neoplasias Mandibulares/cirurgia , Biópsia por Agulha Fina , Queixo/cirurgia , Dermabrasão , Feminino , Humanos , Neoplasias Mandibulares/patologia , Microcirurgia , Pessoa de Meia-Idade , Cicatrização
5.
Clin Plast Surg ; 47(1): 91-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739902

RESUMO

The concept of microautologous fat transplantation (MAFT), proposed by Lin and colleagues in 2007, emphasized that the volume of each delivered parcel should be less than 0.01 mL to avoid potential fat grafting morbidities. The MAFT-GUN facilitates control of the parcel volume and therefore substantially avoids central necrosis and associated complications. In this article, the authors present a simple, reliable, and consistent procedure based on MAFT for profiloplasty. Favorable outcomes with sustainable long-term effectiveness were obtained, further confirming that the MAFT technique is an alternative for facial contouring in the nose and chin.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal , Queixo/cirurgia , Nariz/cirurgia , Humanos , Transplante Autólogo
6.
J Craniofac Surg ; 31(3): 632-636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31856136

RESUMO

The purpose of this study was to document changes in social perceptions and facial esthetics, and document occlusion outcomes in a series of short face (SF) dentofacial deformity (DFD) subjects. The investigators hypothesized that subjects would achieve positive change in social perceptions and facial esthetics, and maintain a long-term corrected occlusion after undergoing bimaxillary and chin osteotomies.A retrospective cohort study was implemented. Photographic records and occlusion parameters were studied preoperatively and >2 years after surgery. The first outcome variable was social perceptions of SF subjects, judged by laypersons. The second outcome variable was facial esthetics, judged by professionals. The third outcome variable was occlusion maintained long-term.Fifteen subjects met inclusion criteria. Mean age at operation was 33 years. Consistent facial contour deformities at presentation included deficient maxillary dental show and downturned oral commissures. As a group, there was improvement (P < 0.05) in 11 of 12 social perceptions, judged by laypersons, all subjects achieved correction of the facial esthetic parameters studied by professionals, and all subjects maintained a favorable occlusion long-term.In SF DFD subjects, bimaxillary and chin surgery proved effective to improve social perceptions, to correct facial contour deformities, and in achieving a long-term corrected occlusion.


Assuntos
Queixo/cirurgia , Deformidades Dentofaciais/cirurgia , Face/cirurgia , Maxila/cirurgia , Anormalidades Musculoesqueléticas/cirurgia , Adolescente , Adulto , Queixo/diagnóstico por imagem , Oclusão Dentária , Deformidades Dentofaciais/diagnóstico por imagem , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Procedimentos Cirúrgicos Ortognáticos , Fotografação , Estudos Retrospectivos , Percepção Social , Cirurgia Plástica , Resultado do Tratamento , Adulto Jovem
7.
Cir. plást. ibero-latinoam ; 45(4): 395-402, oct.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186026

RESUMO

Introducción y objetivo: El colgajo submentoniano ha sido descrito como alternativa para la cobertura de defectos cutáneos en tercio medio e inferior de la cara y como colgajo microquirúrgico para tratamiento del linfedema secundaria de extremidades, al incorporar en su diseño nódulos linfáticos vascularizados. El presente estudio pretende justificar el uso del colgajo submentoniano en sus distintas variantes con la incorporación tradicional de músculo digástrico, perforante de arteria submentoniana, de flujo reverso o microquirúrgico, y con mínima morbilidad del sitio donador. Material y método: Presentamos una serie de 8 pacientes en los que realizamos un colgajo submentoniano para cobertura de defectos en tercio medio e inferior de cara y de linfedema secundario de extremidad superior. Los colgajos tuvieron dimensiones de 40 a 84 cm2 (media de 62 cm2). Los colgajos fueron pediculados con base en la arteria submentoniana en 4 casos (50%), con preservación del músculo digástrico basado en un vaso perforante de la arteria submentoniana en 2 casos, como colgajo submentoniano de flujo reverso en 1 caso, y como colgajo submental linfático vascularizado en 1 caso. Resultados: Recogimos como complicación una necrosis parcial distal de un 20% en un colgajo submentoniano de flujo reverso, que fue tratada con cicatrización dirigida a segunda intención. La zona donadora se trató en todos los casos con cierre primario. Conclusiones: En nuestra opinión, el colgajo submentoniano es una herramienta útil en la reconstrucción de tejidos blandos del tercio medio e inferior de la zona facial, con un grosor, textura y coloración similares, así como una alternativa en el tratamiento del linfedema secundaria de la extremidad superior


Background and objective: The submental flap has been previously described as an alternative for the coverage of cutaneous defects or the middle and lower thirds of the face, as well as a vascularized lymph node flap for the treatment of secondary lymphedema of the extremities. Our goal is to justify its clinical application, and the use of the variants of the components of the flap and design, either with the inclusion of the digastric muscle, submental perforator, reverse flow or microvascular flap, with minimal complications. Methods: We present a series of 8 patients in which a submental flap was performed to restore cutaneous defects of the middle and lower thirds of the face, and the treatment of secondary lymphedema of the upper extremity. Flaps dimensions were between 40 to 84 cm2 (average of 62 cm2). The flap was designed as submental pedicled flap in 4 cases (50%), with preservation of digastric muscle based on a submental perforator in 2 cases, reverse flow submental flap in 1 case, and as a vascularized submental lymph node transfer flap y 1 case. Results: Complications occurred in 1 of the cases, presented as a partial necrosis of a 30% of a submental reverse flow flap, which healed by secondary intention. Donor site was closed primarily in all the cases. Conclusions: In our opinion, the submental flap is a good choice for the coverage of cutaneous defects of the middle and lower face, providing a thickness, texture and color similar to neighboring tissues, as well as an alternative for the treatment of secondary lymphedema of the upper extremity


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Retalhos Cirúrgicos/cirurgia , Queixo/cirurgia , Carcinoma Basocelular/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Queixo/patologia , Anormalidades da Pele/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/secundário , Extremidade Superior/patologia , Extremidade Superior/cirurgia , Estudos Retrospectivos
10.
Facial Plast Surg ; 35(5): 499-515, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31639875

RESUMO

After studying this article, the reader should be able to understand how various implants, osteotomies, and reductive tissue techniques affect the aesthetic outcomes of chin reshaping surgery. The roles of standard versus custom chin implants, the operative steps and indications for a bony genioplasty and the techniques for chin reduction are described with emphasis on proper patient selection and avoiding their common complications.


Assuntos
Queixo , Estética Dentária , Procedimentos Cirúrgicos Reconstrutivos , Queixo/cirurgia , Mentoplastia , Humanos , Osteotomia
12.
J Craniofac Surg ; 30(7): 2174-2177, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31425405

RESUMO

BACKGROUND: Underdevelopment of nose and chin in East Asians is quite common. Rhinoplasty and mentoplasty are effective procedures to solve the above-depicted defects and can achieve remarkable cosmetic effects. An autologous costal cartilage graft has become an ideal material for rhinoplasty, especially for revision surgery. However, many problems in the clinical application of costal cartilage remain unresolved. This study is to investigate application strategies of autologous costal cartilage grafts in rhino- and mentoplasty. METHODS: The methods involved are as follows: application of an integrated cartilage scaffold; comprehensive application of diced cartilage; and chin augmentation of an autologous costal cartilage graft. RESULTS: In this study, satisfactory facial contour appearance was immediately achieved in 28 patients after surgery; 21 patients had satisfactory appearance of the nose and chin during the 6- to 18-month follow-up. Cartilage resorption was not observed. Two patients had nasal tip skin redness and were cured after treatment. CONCLUSION: This procedure can be used to effectively solve: curvature of the costal cartilage segment itself; warping of the carved costal cartilage; and effective use of the costal cartilage segment. The procedure has achieved satisfactory outcomes, and its application is worth extending to clinical practice.


Assuntos
Cartilagem Costal/transplante , Mentoplastia , Rinoplastia , Adolescente , Adulto , Autoenxertos/cirurgia , Queixo/cirurgia , Feminino , Humanos , Nariz/cirurgia , Adulto Jovem
14.
J Craniofac Surg ; 30(8): 2486-2489, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469743

RESUMO

We reported a 16-year-old patient with chin defect accompanying micrognathia and airway stenosis owing to a traffic accident. The treatment of this patient involved a modified genioplasty associated with orthognathic surgeries. Through data analysis, we found that the patient's facial morphology and airway space are greatly improved compared with preoperation: y-axis(T4-T1) = -4.5 degree; FCA (T4-T1) = -18 degree; CSAmin(T4-T1) = 227 mm. In conclusion, the modified genioplasty associated with orthognathic surgeries is an effective way to reshape the defected chin and treat micrognathia and airway stenosis in this case.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Queixo/cirurgia , Mentoplastia , Micrognatismo/cirurgia , Adolescente , Humanos , Masculino , Procedimentos Cirúrgicos Ortognáticos
15.
J Craniofac Surg ; 30(8): 2599-2600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369511

RESUMO

This work presents the wrap technique developed by the authors aiming to avoid the occurrence of unaesthetic deep labiomental fold in genioplasty. The technique recommends the use of particulate bone graft that is wrapped on collagen or a Surgicel membrane which is placed over the osteotomized segment of the chin fixated with a prebent 4-hole titanium plate.


Assuntos
Transplante Ósseo/métodos , Queixo/cirurgia , Mentoplastia , Humanos
16.
J Craniofac Surg ; 30(5): 1359-1363, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299722

RESUMO

BACKGROUND: Lower face contouring surgery has become a popular aesthetic surgery in East Asian countries. Various surgical methods have been used to improve lower face aesthetics. When a patient has a wide as well as long lower face, procedures like chin polishing or T-type osteotomy are traditionally performed, but these surgical methods have several disadvantages. The authors devised a simple and reliable method to correct the wide and long lower face, without the complications associated with the traditional methods. METHODS: From July 2015 to January 2018, 30 patients with a prominent mandibular angle, long chin, and no malocclusion underwent en-bloc mandibular U-shaped osteotomy through an oral incision, in order to shorten the mandibular angle, body of the mandible, and the chin, and to improve the facial contour. The authors assessed the effectiveness of surgery through comparisons between pre- and postoperative radiographs, patient satisfaction, and surgical complications in the postoperative period. RESULTS: It was observed that all oral incisions healed by primary intention, and did not develop hematoma, infection, or osteonecrosis. Lower lip numbness occurred in 16 patients. After 6 to 12 months, all patients showed complete recovery from the numbness. All the patients were satisfied with their appearance after surgery. CONCLUSIONS: En-bloc mandibular U-shaped osteotomy is an improved form of mandibular surgery. The osteotomy line involves the whole mandible, which makes the length and width of the mandible considerably smaller. This surgery can effectively correct a prominent mandibular angle with long chin.


Assuntos
Queixo/cirurgia , Mandíbula/cirurgia , Adulto , Feminino , Humanos , Hipestesia/etiologia , Lábio/cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Osteotomia , Satisfação do Paciente , Complicações Pós-Operatórias , Período Pós-Operatório
18.
J Plast Reconstr Aesthet Surg ; 72(8): 1272-1277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31175030

RESUMO

BACKGROUND: Variable flap loss rates for the platysma myocutaneous flap have been reported for the Caucasian and the Asian population, which are 10.1% and 1.6%, respectively. This study was designed to investigate ethnic differences in the number and location of platysmal perforators that influence flap survival rates. METHODS: The number and location of platysmal perforators were investigated in a total of 60 platysma muscles: bilaterally in 20 Caucasian (13 males and 7 females) and 10 Asian (5 males and 5 females) specimens using cadaveric dissections. Adjustment for inter-individual variability in platysma length and width was performed by standardizing each x-value to mandibular length and each y-value to mandibulo-clavicular distance. RESULTS: A total of 64% of all detected platysmal perforators were found in the medial half of the muscle following the pathway of the external carotid artery. Individuals of Caucasian ethnicity had a mean number of 7.60 ± 2.0 perforators per side, whereas individuals of Asian ethnicity had a mean number of 13.05 ± 1.76 perforators per side (p < 0.001). Individuals of Asian ethnicity had a statistically significant increased number of platysmal perforators in the medial middle (2.95 ± 1.05 vs. 1.60 ± 1.08; p < 0.001) and lower (1.60 ± 1.35 vs. 0.73 ± 0.85; p = 0.003) regions of the platysma compared to those of Caucasian individuals. CONCLUSION: A significantly higher number of platysmal perforators were identified in the investigated Asian population. This provides a potential explanatory model for the reported lower platysma myocutaneous flap loss rates in the Asian population than in the Caucasian population.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Retalho Miocutâneo/transplante , Retalho Perfurante/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sistema Musculoaponeurótico Superficial/transplante , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Carcinoma de Células Escamosas/cirurgia , Queixo/cirurgia , Neoplasias Faciais/cirurgia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Fatores Sexuais , Sistema Musculoaponeurótico Superficial/irrigação sanguínea
20.
Orthod Fr ; 90(1): 75-100, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30994451

RESUMO

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.


Assuntos
Queixo/cirurgia , Assimetria Facial/cirurgia , Mentoplastia/métodos , Mandíbula/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Cefalometria , Estudos de Coortes , Feminino , Humanos , Masculino , Má Oclusão de Angle Classe III/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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