Common craniofacial anomalies: conditions of craniofacial atrophy/hypoplasia and neoplasia

Polymeric Nanocomposite Hydrogel Scaffolds in Craniofacial Bone Regeneration: A Comprehensive Review

Nanocomposite biomaterials combine a biopolymeric matrix structure with nanoscale fillers. These bioactive and easily resorbable nanocomposites have been broadly divided into three groups, namely natural, synthetic or composite, based on the polymeric origin. Preparing such nanocomposite structures in the form of hydrogels can create a three-dimensional natural hydrophilic atmosphere pivotal for cell survival and new tissue formation. Thus, hydrogel-based cell distribution and drug administration have evolved as possible options for bone tissue engineering and regeneration. In this context, nanogels or nanohydrogels, created by cross-linking three-dimensional polymer networks, either physically or chemically, with high biocompatibility and mechanical properties were introduced as promising drug delivery systems. The present review highlights the potential of hydrogels and nanopolymers in the field of craniofacial tissue engineering and bone regeneration.

Core Extirpation and Zygoma Reduction: A New Surgical Approach for Fibrous Dysplasia of Zygomaticomaxillary Region

INTRODUCTION

In case of zygomaticomaxillary fibrous dysplasia (FD), surgical treatment is often required due to visual disturbance, exophthalmos, and also necessary for cosmetic reasons. However, it is not easy to determine the timing and method of operation. The objective of our study is to define a new surgical option, for the treatment of FD of zygomaticomaxillary area.

MATERIALS AND METHODS

Five patients affected by FD of their zygomaticomaxillary area who underwent surgery with a core extirpation were included in this study. A retrospective chart review and pre- and post-operative analysis of computed tomography scan were performed.

RESULTS

All patients underwent core extirpation surgery and zygoma reduction was combined in 2 patients. All patients showed the cessation of the increase of external size postoperatively and results of the operation were well maintained over the follow-up period of 1 year.

CONCLUSIONS

In this article, we present our experiences in the management of FD using the core extirpation with or without zygoma reduction, focusing on surgical indication, techniques, and results. Although there are limitations due to selective operative indication, the procedure can be usefully performed to prevent external growth and avoid repetitive surgery.

Strategies of Prevascularization in Tissue Engineering and Regeneration of Craniofacial Tissues

Craniofacial tissue defects caused by trauma, developmental malformation, or surgery are critical issues of high incidence, which are harmful to physical and psychological health. Transplantation of engineered tissues or biomaterials is a potential method to repair defects and regenerate the craniofacial tissues. Revascularization is essential to ensure the survival and regeneration of the grafts. Since microvessels play a critical role in blood circulation and substance exchange, the pre-establishment of the microvascular network in transplants provides a technical basis for the successful regeneration of the tissue defect. In this study, we reviewed the recent development of strategies and applications of prevascularization in tissue engineering and regeneration of craniofacial tissues. We focused on the cellular foundation of the in vitro prevascularized microvascular network, the cell source for prevascularization, and the strategies of prevascularization. Several key strategies, including coculture, microspheres, three-dimensional printing and microfluidics, and microscale technology, were summarized and the feasibility of these technologies in the clinical repair of craniofacial defects was discussed.

Augmented reality navigation method for recontouring surgery of craniofacial fibrous dysplasia

The objective of this study is to introduce the application of augmented reality (AR) navigation system developed by the authors in recontouring surgery of craniofacial fibrous dysplasia. Five consecutive patients with craniofacial fibrous dysplasia were enrolled. Through three-dimensional (3D) simulation, a virtual plan was designed to reconstruct the normal anatomical contour of the deformed region. Surgical recontouring was achieved with the assistance of the AR navigation system. The accuracy of the surgical procedure was assessed by superimposing the post-operative 3D craniomaxillofacial model onto the virtual plan. The pre-operative preparation time and operation time were also counted. In all patients, AR navigation was performed successfully, with a mean ± SD of the errors of 1.442 ± 0.234 mm. The operative time of the patients ranged from 60 to 80 min. The pre-operative preparation time was 20 min for each patient. All the patients showed uneventful healing without any complications, in addition to satisfaction with the post-operative aesthetics. Using our AR navigation system in recontouring surgery can provide surgeons with a comprehensive and intuitive view of the recontouring border, as well as the depth, in real time. This method could improve the efficiency and safety of craniofacial fibrous dysplasia recontouring procedures.

Aesthetic Restoration of Severe Hemifacial Atrophy With Free Adipofacial Antero Lateral Thigh Flap Followed by Autologous Fat Grafting; Optimizing Result and Long-Term Outcome

BACKGROUND

Hemifacial atrophy (Romberg disease) is characterized by progressive soft tissue and bone atrophy on 1 side of the face. The process of atrophy usually starts in the late first or early second decade of life. Romberg Patients usually require soft tissue augmentation for the correction of their defect. There are many reconstructive tools available to correct such facial asymmetry. In this study, we evaluate the outcome of the free adipofacial flap followed by autologous fat grafting in the treatment of Romberg disease, regarding aesthetics and longevity of the treatment.

PATIENTS AND METHODS

A retrospective review of 12 patients with moderate to severe hemifacial atrophy from April 2016 till March 2019. All patients received soft tissue augmentation with free adipofascial anterolateral thigh flaps, followed by autologous fat grafting 6 to 12 months later for correction of residual deformity. The average follow-up period was 18 months (range, 6-30).

RESULTS

There were 9 females and 3 males in this study. All flaps were survived, and the effect is long-lasting during follow-up. Patients were satisfied with the result especially after refinement of the result of free tissue transfer. The donor sites were closed directly and with no apparent morbidities nor dysfunctions.

CONCLUSIONS

Microsurgical free tissue transfer is considered a gold standard tool in the management of moderate and severe form of hemifacial atrophy. Among different flaps available, free adipofacial anterolateral thigh flap (ALT) works as a workhorse flap in the correction of a severe form of the disease. Autologous fat grafting is a versatile and reliable option to correct residual deformities. We believed that such a combination is a superb approach to optimize the outcome of the severe form of the progressive hemifacial atrophy.

Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report

Background

Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction.

Case presentation

This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort.

Conclusions

In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.

Treatment of fibrous dysplasia of the zygomaticomaxillary complex with radical resection and three-dimensional reconstruction with autologous calvarial bone graft

Fibrous dysplasia (FD) is a rare, benign bone disease with abnormal bone maturation and fibroblastic proliferation. Optimal treatment of zone 1 craniofacial FD is radical resection and reconstruction. To achieve of structural, aesthetic, and functional goals, we use three-dimensionally designed calvarial bone graft for reconstruction of zygomatic defect after radical resection of FD. The authors used a rapid-prototyping model for simulation surgery for radical resection and immediate reconstruction. Donor site was selected from parietal bone reflect shape, contour, and size of defect. Then radical resection of lesion and immediate reconstruction was performed as planned. Outcomes were assessed using clinical photographs and computed tomography scans. Successful reconstruction after radical resection was achieved by three-dimensional calvarial bone graft without complications. After a 12-month follow-up, sufficient bone thickness and symmetric soft tissue contour was well-maintained. By considering three-dimensional configuration of zygomaticomaxillary complex, the authors achieved satisfactory structural, aesthetic and functional outcomes without complications.

Cystic Degeneration of Craniofacial Fibrous Dysplasia

BACKGROUND

Fibrous dysplasia (FD) is most often a slowly progressive benign disease in which the normal bone structure is replaced by fibrous and osteoid tissue.

CASE DESCRIPTION

A 16-year-old adolescent, known with FD in the sphenoid bone, suffered an acute decreased visual acuity with papilledema on the left eye. The radiologic images were best compatible with cystic degeneration of the known FD with optic nerve compression in the optic canal. Decompression of the optic nerve was performed through an endoscopic exploration of the left sphenoid sinus. The visual acuity recovered completely.

CONCLUSIONS

In FD with cystic changes, leading to acute signs of optic nerve compression, early aggressive surgical decompression is strongly recommended. Cystic degeneration of the FD, although rare, should be considered.

A review of craniofacial and dental findings of the RASopathies

OBJECTIVES

The RASopathies are a group of syndromes that have in common germline mutations in genes that encode components of the Ras/mitogen-activated protein kinase (MAPK) pathway and have been a focus of study to understand the role of this pathway in development and disease. These syndromes include Noonan syndrome (NS), Noonan syndrome with multiple lentigines (NSML or LEOPARD syndrome), neurofibromatosis type 1 (NF1), Costello syndrome (CS), cardio-facio-cutaneous (CFC) syndrome, neurofibromatosis type 1-like syndrome (NFLS or Legius syndrome) and capillary malformation-arteriovenous malformation syndrome (CM-AVM). These disorders affect multiple systems, including the craniofacial complex. Although the craniofacial features have been well described and can aid in clinical diagnosis, the dental phenotypes have not been analysed in detail for each of the RASopathies. In this review, we summarize the clinical features of the RASopathies, highlighting the reported craniofacial and dental findings.

METHODS

Review of the literature.

RESULTS

Each of the RASopathies reviewed, caused by mutations in genes that encode different proteins in the Ras pathway, have unique and overlapping craniofacial and dental characteristics.

CONCLUSIONS

Careful description of craniofacial and dental features of the RASopathies can provide information for dental clinicians treating these individuals and can also give insight into the role of Ras signalling in craniofacial development.

Facial asymmetry with enlarged frontal sinus and hyperplasia of the cranial, nasal, and mandible bones

The conditions of facial asymmetry are caused by congenital or acquired diseases, and several unclassifiable syndromes with unknown etiologies exist. In this report, a case of facial asymmetry with enlarged frontal sinus and hyperplasia of the frontal cranial bone and nasal bone is presented. Although the etiology of the facial malformation was clear, it was thought that the cause of the enlarged frontal sinus was related to the unidentified bony hyperplasia and facial asymmetry related to hemimandibular hyperplasia.

Microsurgical correction of progressive facial hemiatrophy using free anterolateral thigh adipofascial flap

BACKGROUND

The etiology of progressive facial hemiatrophy is unclear according to resent research. The diseases lack effective treatments. The purpose of this study was to introduce a technique that restores the cosmetic amelioration effectively using free anterolateral thigh adipofascial flap through anastomosis.

METHODS

From September 1999 to June 2011, a total of 14 patients were subjected to correction with revascularized free anterolateral thigh adipofascial flaps at the first stage. Some of them performed additional procedures, such as dermal fat flap filling, lipoinjection, liposuction, and thinning of the flap, were used for secondary minor deformities after the first-stage operation. The donor sites were closed primarily without skin grafting or other flap transplantation.

RESULTS

All of the flaps survived, and the effect is stable during the follow-ups. Patients were quite satisfied with the symmetry and plumpness of the reconstructed faces. The donor sites were sutured directly and healed at the first stage; there were no obvious morbidities and dysfunctions.

CONCLUSIONS

The anterolateral thigh adipofascial flap can provide adequate tissue with reliable blood supply, pliability, ease of revision, and minimal morbidity and dysfunction at the donor site. It is a safe, stable, and effective technique for hemifacial atrophy.

Bone repair cells for craniofacial regeneration

Reconstruction of complex craniofacial deformities is a clinical challenge in situations of injury, congenital defects or disease. The use of cell-based therapies represents one of the most advanced methods for enhancing the regenerative response for craniofacial wound healing. Both somatic and stem cells have been adopted in the treatment of complex osseous defects and advances have been made in finding the most adequate scaffold for the delivery of cell therapies in human regenerative medicine. As an example of such approaches for clinical application for craniofacial regeneration, Ixmyelocel-T or bone repair cells are a source of bone marrow derived stem and progenitor cells. They are produced through the use of single pass perfusion bioreactors for CD90+ mesenchymal stem cells and CD14+ monocyte/macrophage progenitor cells. The application of ixmyelocel-T has shown potential in the regeneration of muscular, vascular, nervous and osseous tissue. The purpose of this manuscript is to highlight cell therapies used to repair bony and soft tissue defects in the oral and craniofacial complex. The field at this point remains at an early stage, however this review will provide insights into the progress being made using cell therapies for eventual development into clinical practice.

Facial reconstruction with vascularised serratus anterior muscle flap in patients with Parry-Romberg syndrome

OBJECTIVE

Parry-Romberg syndrome, popularly known as progressive hemifacial atrophy, is a rare and complicated craniofacial deformity characterized by idiopathic and progressive atrophy of patient's face with compromised facial aesthetics and functions. In the present study, we performed a retrospective review on the vascularised serratus anterior muscle flap transfer for the treatment of the hemifacial atrophy in 4 consecutive Chinese patients with Parry-Romberg syndrome.

METHODS

The serratus anterior muscle flaps were harvested and transferred to correct the facial defects together with simultaneous nerve anastomosis between the long thoracic nerve and the ipsilateral cervical branch of facial nerve in the patients with Parry-Romberg syndrome. The postoperative results from patients' own perception of improvement of facial profile and symmetry were also evaluated.

RESULTS

In this patient series, both of the vessels and nerves of all flaps were anastomosed successfully in the recipient facial regions without any microvascular failures. Satisfactory facial contour and favorable symmetry were achieved with minimal donor-site morbidity, complications, recurrence and little resorption in surgical reconstruction of hemifacial atrophy during our follow-up period.

CONCLUSIONS

Our results suggested that vascularised serratus anterior muscle flap transfer combined with simultaneous nerve anastomosis is a reliable and effective treatment of choice that offers satisfactory results in the surgical correction of facial atrophy associated with Parry-Romberg syndrome.

Micro-well texture printed into PEG hydrogels using the FILM nanomanufacturing process affects the behavior of preadipocytes

To date, biomaterial scaffolds for adipose tissue engineering have focused on macro- and upper micro-scale fabrication, biocompatibility, and biodegradation, but have failed to recapitulate the sub-micron dimensions of native extracellular matrix (ECM) and, therefore, have not optimized material-cell interactions. Here, we report the findings from a study investigating the effects of a quasi-mimetic sub-micron (< 1 micrometer) surface texture on the qualitative behavior of preadipocytes (PAs). We found that PAs in contact with tread-like micro-well structures exhibit a different morphology relative to PAs seeded onto control smooth glass surfaces. Additionally, the micro-well topography induced isolated PAs to undergo adipogenesis, which usually occurs in the presence of aggregates of contact-inhibited PAs. The micro-well structures were printed into polyethylene glycol dimethacrylate (PEGDMA) using the recently reported nanomanufacturing process called Flash Imprint Lithography Using a Mask Aligner (FILM). FILM is a simple process that can be utilized to fabricate micro- and nanostructures in UV-curable materials (D.Y. Fozdar, W. Zhang, M. Palard, C.W. Patrick Jr., S.C. Chen, Flash Imprint Lithography Using A Mask Aligner (FILM): A Method for Printing Nanostructures in Photosensitive Hydrogels for Tissue Engineering. Nanotechnology 19, 2008). We demonstrate the utilization of the FILM process for a tissue engineering application for the first time. The micro-well topographical theme is characterized by contact angle and surface energy analysis and the results were compared with those for smooth glass and unpatterned PEGDMA surfaces. Based on our observations, we believe that the micro-well texture may ultimately be beneficial on implantable tissue scaffolds.

Cyst degeneration in craniofacial fibrous dysplasia: clinical presentation and management

Object

Fibrous dysplasia (FD) is a common osseous tumor that may affect the craniofacial skeleton. Cyst degeneration may occur within an existing FD lesion, manifesting as acute clinical deterioration. Because existing reports of this entity are limited, the object of this study was to describe the presentation and management of cyst degeneration in a relatively large series of patients.

Methods

For nine patients who were treated for cyst degeneration of craniofacial FD the following data were reviewed: demographic factors, clinical presentation, tumor type, computed tomography (CT) findings, surgical management, intraoperative findings, and histopathological findings.

Results

The mean age at tumor presentation was 14.9 years. Seven patients had received a diagnosis of FD before the acute changes of cyst degeneration occurred; this change occurred between 1 and 7 years after the initial diagnosis. The most common presenting symptoms were sudden mass enlargement (78% of patients) and pain (67%). No predisposing factor for cystic change was identified. Four patients presented with visual disturbance; blindness developed in two despite optic nerve decompression. Cyst degeneration occurred most commonly in the sphenoid and frontal bones. The cysts' appearance ranged from a simple lesion to aneurysmal bone cyst.

Conclusions

Cyst degeneration may occur spontaneously within the FD lesion years after the initial diagnosis. Evaluation with CT scanning remains effective in the diagnosis and monitoring of disease progression, and in treatment planning. Surgical intervention is indicated for patients with symptoms or functional impairment. Optimal management of this entity has been facilitated through careful collaboration between neurosurgeons and plastic surgeons.

Restrictive strabismus in Parry-Romberg syndrome

Forced duction and generation testing of a patient with Parry-Romberg syndrome (progressive hemifacial atrophy) confirmed that his incomitant hypotropia and esotropia were restrictive and not due to nerve paresis. This suggests that an orbital inflammatory process (causing extraocular muscle fibrosis) is part of this rare and poorly understood syndrome.