Injectable hyaluronic acid for the correction of HIV-associated facial lipoatrophy.

OBJECTIVE: To evaluate the use of Perlane, an injectable form of hyaluronic acid, for the correction of HIV-associated facial lipoatrophy. STUDY DESIGN AND SETTING: A prospective, observational study in a consecutive series of 18 HIV-positive males with facial lipoatrophy injected with Perlane. Fourteen patients were available for final analysis. RESULTS: Mean follow-up time was 12 months. Based on photographic analysis, there was a significant early improvement (P = 0.0035). This difference remained significant after 12 months (P = 0.04666); no significant difference in grade was shown between 1 and 12 months (P = 0.3693). Office assessments of improvement showed an early marked improvement in 85.8% of patients, and 78.6% of subjects demonstrated at least moderate improvement at 12 months. CONCLUSION/SIGNIFICANCE: Patient satisfaction was high, with only minor side effects and no late complications. Our findings support Perlane to be a feasible option for the provisional correction of mild to moderate facial lipoatrophy.

Facial atrophy following accidental subcutaneous extrusion of sodium hypochlorite.

Facial atrophy of the buccal fat pad following inadvertent subcutaneous extrusion of sodium hypochlorite is very rare. It is a complication which leaves the patient with a defect which is very difficult to treat. We present the case of a 46-year-old lady who presented with almost complete unilateral atrophy of the buccal fat pad. She has undergone multiple surgeries over the past two years. We highlight the precautions that must be taken to prevent such a complication and the difficulties in rehabilitating such a patient.

Influence of unilateral masseter muscle atrophy on craniofacial morphology in growing rabbits.

PURPOSE: The purpose of the study was to evaluate whether the induction of unilateral masticatory muscle dysfunction can alter the skeletal growth patterns. MATERIALS AND METHODS: Twenty-one white male New Zealand rabbits (4 weeks old) were divided into 3 groups of 7 subjects: group 1 served as the control to study normal craniofacial growth. In groups 2 and 3, rabbits were injected with 5 units and 15 units of Botulinum toxin A (BTXA) into the right masseter muscle, respectively. The effect of a neuromuscular blockade of masseteric activity on craniofacial growth was evaluated with 3 samples of serial computed tomography (CT) scans with a slice thickness of 0.625 mm, taken at 4 weeks (base line), 8 weeks (endpoint of prepubertal craniofacial growth), and 24 weeks (after pubertal growth). RESULTS: The ipsilateral mandibular ramus height, zygomatic arch length, and masseteric length did not develop as much as those of the contralateral side after pubertal growth. At age 24 weeks, the masseter muscle volume asymmetry index reached -13.8% (group 2), -18.4% (group 3), and -1.6% for the control group. The ipsilateral side of the hemimandible showed less bone volume after 8 weeks but it showed partially recovered symmetry at 24 weeks. The maxillomandibular incisor midline and transverse molar discrepancies were not evident in any of the groups. CONCLUSIONS: The BTXA injection can be an effective method in inducing site-specific muscular hypofunctions so that masticatory muscle-craniofacial bone interaction can be investigated efficiently. The result showed that the unilateral atrophy of the masseter muscle in the growing subjects influenced the morphology of the local skeletal sites. This did not, however, result ultimately in mandibular midline asymmetry or right-left asymmetry in hemimandibular volume after growth. The results imply that alterations in specific masticatory muscle function can be compensated by the growth of other structural components.