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Du P, Zhu K, Qiao H, Zhang J, Meng H, Huang Z, Yu Y, Xie S, Allen E, Xiong J, Zhang B, Chang X, Ren X, Xu Y, Zhou Q, Han S, Jin L, Wei P, Wang CC, Wen S. Ancient genome of the Chinese Emperor Wu of Northern Zhou. Curr Biol 2024; 34:1587-1595.e5. [PMID: 38552628 DOI: 10.1016/j.cub.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 12/23/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
Emperor Wu (, Wudi) of the Xianbei-led Northern Zhou dynasty, named Yuwen Yong (, 543-578 CE), was a highly influential emperor who reformed the system of regional troops, pacified the Turks, and unified the northern part of the country. His genetic profile and physical characteristics, including his appearance and potential diseases, have garnered significant interest from the academic community and the public. In this study, we have successfully generated a 0.343×-coverage genome of Wudi with 1,011,419 single-nucleotide polymorphisms (SNPs) on the 1240k panel. By analyzing pigmentation-relevant SNPs and conducting cranial CT-based facial reconstruction, we have determined that Wudi possessed a typical East or Northeast Asian appearance. Furthermore, pathogenic SNPs suggest Wudi faced an increased susceptibility to certain diseases, such as stroke. Wudi shared the closest genetic relationship with ancient Khitan and Heishui Mohe samples and modern Daur and Mongolian populations but also showed additional affinity with Yellow River (YR) farmers. We estimated that Wudi derived 61% of his ancestry from ancient Northeast Asians (ANAs) and nearly one-third from YR farmer-related groups. This can likely be attributed to continuous intermarriage between Xianbei royal families, and local Han aristocrats.1,2 Furthermore, our study has revealed genetic diversities among available ancient Xianbei individuals from different regions, suggesting that the formation of the Xianbei was a dynamic process influenced by admixture with surrounding populations.
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Affiliation(s)
- Panxin Du
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China; State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, and Human Phenome Institute, Fudan University, Shanghai 200433, China; Ministry of Education Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai 200433, China
| | - Kongyang Zhu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361102, China
| | - Hui Qiao
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, and Human Phenome Institute, Fudan University, Shanghai 200433, China; Ministry of Education Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai 200433, China
| | | | - Hailiang Meng
- Ministry of Education Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai 200433, China
| | - Zixiao Huang
- Department of History, Fudan University, Shanghai 200433, China
| | - Yao Yu
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Shouhua Xie
- Department of History, Fudan University, Shanghai 200433, China
| | - Edward Allen
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Jianxue Xiong
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Baoshuai Zhang
- USTC Archaeometry Laboratory, University of Science and Technology of China, Hefei 230026, China
| | - Xin Chang
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Xiaoying Ren
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Yiran Xu
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China
| | - Qi Zhou
- Shanghai Federation of Social Science Associations, Shanghai 200020, China
| | - Sheng Han
- Department of History, Fudan University, Shanghai 200433, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, and Human Phenome Institute, Fudan University, Shanghai 200433, China.
| | - Pianpian Wei
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China.
| | - Chuan-Chao Wang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361102, China; Department of Anthropology and Ethnology, Institute of Anthropology, Fujian Provincial Key Laboratory of Philosophy and Social Sciences in Bioanthropology, School of Sociology and Anthropology, Xiamen University, Xiamen 361005, China; State Key Laboratory of Marine Environmental Science, Xiamen University, Xiamen 361102, China; Institute of Artificial Intelligence, Xiamen University, Xiamen 361005, China.
| | - Shaoqing Wen
- Institute of Archaeological Science, Fudan University, Shanghai 200433, China; Ministry of Education Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai 200433, China; MOE Laboratory for National Development and Intelligent Governance, Fudan University, Shanghai 200433, China; Center for the Belt and Road Archaeology and Ancient Civilizations, Shanghai 200433, China.
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2
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Shi KY, Matsumoto A, Nijhawan RI. Repair of a combined nasal sidewall/cheek/medial canthus defect. J Am Acad Dermatol 2024; 90:e123-e124. [PMID: 37187425 DOI: 10.1016/j.jaad.2023.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/18/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Kevin Y Shi
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Matsumoto
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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3
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Grande DP, Auger SR, Bolotin D, Meleca JB. Recurrent Postoperative Hemorrhage After Mohs Reconstruction in a Patient on Ruxolitinib. OTO Open 2024; 8:e133. [PMID: 38618287 PMCID: PMC11009940 DOI: 10.1002/oto2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- David P. Grande
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Samuel R. Auger
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Diana Bolotin
- Section of Dermatology, Department of MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Joseph B. Meleca
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Chicago MedicineChicagoIllinoisUSA
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Whitman P, Boyd J, Lear W. Bilobed flap design using a cotton tip applicator. J Am Acad Dermatol 2024:S0190-9622(24)00123-3. [PMID: 38278419 DOI: 10.1016/j.jaad.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Patrick Whitman
- Frontier Dermatology, Salem, Oregon; Samaritan Health Services - Corvallis Micrographic Surgery and Dermatologic Oncology Fellowship, Corvallis, Oregon
| | - Jacob Boyd
- Frontier Dermatology, Salem, Oregon; Samaritan Health Services - Corvallis Dermatology Residency, Salem, Oregon.
| | - William Lear
- Frontier Dermatology, Salem, Oregon; Samaritan Health Services - Corvallis Micrographic Surgery and Dermatologic Oncology Fellowship, Corvallis, Oregon
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Russo R, Pentangelo P, Ceccaroni A, Losco L, Alfano C. Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients. J Clin Med 2024; 13:554. [PMID: 38256687 PMCID: PMC10816608 DOI: 10.3390/jcm13020554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Lower lip reconstruction is crucial to restore oral integrity post-cancer excision. A perfect balance between form and function should be achieved. With an aging demographic, adapting surgical methods to meet the unique needs of the elderly becomes imperative. Our study aims to introduce a specialized algorithm for lower lip reconstruction; it was tailored to geriatric patients and emphasized the use of "simpler flaps". Additionally, "Pearls and Pitfalls" were provided for surgeons approaching lower lip reconstruction. METHODS Between January 2018 and June 2021, a retrospective study was carried out. Data collection included patient demographics, defect attributes, reconstructive approaches, flap viability assessment, wound healing, and complications. The follow-up was carried out for a period of a minimum of 6 months. RESULTS Among 78 patients, squamous cell carcinoma predominated with a mean defect area of 3308 cm2. Postoperative complications were recorded in two patients. All patients reported sensory restoration and overall satisfaction at the 6-month follow-up; secondary procedures were not necessary. CONCLUSION Our reconstructive algorithm, focused on elderly patients, prioritizes less invasive reconstructive techniques and introduces innovative modifications to the established methods to achieve both aesthetic and functional outcomes with a low complication rate. In patients undergoing lower lip reconstruction, the subjective microstomia was found to be less relevant than the objective microstomia.
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Affiliation(s)
| | | | | | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (R.R.); (P.P.); (A.C.); (C.A.)
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Nadeem W, Ferrell JK, Taylor CB. Peronea Magna: An Important Anatomic Variant Impacting Fibula-Free Flap Reconstruction. OTO Open 2024; 8:e121. [PMID: 38420350 PMCID: PMC10900915 DOI: 10.1002/oto2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Wasiq Nadeem
- Department of Otolaryngology–Head and Neck SurgeryUT Health San AntonioSan AntonioUSA
| | - Jay K. Ferrell
- Department of Otolaryngology–Head and Neck SurgeryUT Health San AntonioSan AntonioUSA
| | - Christine B. Taylor
- Department of Otolaryngology–Head and Neck SurgeryUT Health San AntonioSan AntonioUSA
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Cho K, Park J, Eun S. The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation. J Clin Med 2023; 12:7148. [PMID: 38002760 PMCID: PMC10672586 DOI: 10.3390/jcm12227148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to demonstrate the efficacy of radial forearm-free flaps as an ideal choice for various central facial unit reconstructions. METHODS This study encompassed patients treated between 2020 and 2022 who underwent facial reconstruction using radial forearm flaps. These flaps were employed in eleven patients with defects involving the lower lid, nose, upper lip, and lower lip. Additionally, we used osteocutaneous flaps in one patient to reconstruct a right nasal bone defect. In three patients requiring medial and lateral canthal tendon reconstruction in one case and oral sphincter reconstruction in two cases, the palmaris longus tendon was included with the flap. RESULTS In the majority of cases, we achieved good to excellent aesthetic and functional results. Notably, there were no instances of flap failure or partial necrosis in this series. All patients experienced uneventful healing at the donor site. CONCLUSIONS The radial forearm-free flap stands as an ideal and reliable method for reconstructing various facial defects. It offers efficient and thin-conforming skin coverage.
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Affiliation(s)
| | | | - Seokchan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (K.C.); (J.P.)
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Park E, Chang J, Park J. Facial Soft Tissue Thickness Differences among Three Skeletal Classes in Korean Population Using CBCT. Int J Environ Res Public Health 2023; 20:2658. [PMID: 36768023 PMCID: PMC9914978 DOI: 10.3390/ijerph20032658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Studies related to facial soft tissue thickness (FSTT) have been conducted since the late 19th century. Soft tissue is any tissue in the body that is not hardened by ossification or calcification processes, such as bones and teeth; and varies according to sex, age, race, and nutritional status. Forensically, soft tissue thickness plays an important role in cases where a cadaver has no unique characteristics; and the remains cannot be identified through DNA analysis, fingerprints, or examination of dental records. Therefore, the results of the current study suggest that the average thickness of the three skeletal classes (i.e., straight, concave, and convex) should be used for face restoration and forensic art research. It is thought that the current study's results will be invaluable in the fields of forensic science, forensic art, anthropology, and dentistry. As a result, gender differences were observed in all classes, and the facial tissue thickness in Korean adults differed according to gender and occlusion type.
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Affiliation(s)
- Eunseo Park
- Department of Oral Anatomy, College of Dental, Dankook University, Dankook Institute for Future Science and Emerging Convergence, Cheonan 31116, Republic of Korea
- Department of Bio-Health Convergency Open Sharing System, Dankook University, Cheonan 31116, Republic of Korea
| | - Jisuk Chang
- Department of Bio-Health Convergency Open Sharing System, Dankook University, Cheonan 31116, Republic of Korea
- Department of Sport Management, College of Sports Science, Dankook University, Cheonan 31116, Republic of Korea
| | - Jongtae Park
- Department of Oral Anatomy, College of Dental, Dankook University, Dankook Institute for Future Science and Emerging Convergence, Cheonan 31116, Republic of Korea
- Department of Bio-Health Convergency Open Sharing System, Dankook University, Cheonan 31116, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Cheonan 31116, Republic of Korea
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Fatani B, Alabood AA, Alkhayatt NM, Alzahrani HH, Al-Safadi A. Facial Reconstruction Using Sternocleidomastoid (SCM) Flap: A Review of the Literature. Cureus 2023; 15:e34575. [PMID: 36883082 PMCID: PMC9985697 DOI: 10.7759/cureus.34575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of pharyngo-cutaneous fistulas, and augmentation of soft tissue defects in the oral and maxillofacial region. However, this flap is not yet commonly used due to doubtful blood supply to the flap. This flap offers favorable esthetic results, combined flap, rich vascularization, and the possibility of shifting the two heads of the muscle. Thus, this flap has been used broadly in the maxillofacial region to reconstruct the defects of the post-parotidectomy, mandible, pharynx, and floor of the mouth defects. Previous studies discussed the use of a SCM flap following parotidectomy. However, few studies explained the use of SCMs in facial reconstruction. This study aims to review published articles discussing the use of SCMs for facial reconstruction.
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Affiliation(s)
- Bader Fatani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | | | | | - Hadeel H Alzahrani
- College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Afraa Al-Safadi
- Surgery and Pharmacy, King Khaled University Hospital, King Saud University Medical City, Riyadh, SAU
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Mohapatra DP, Friji MT, Dinesh Kumar S, Chittoria RK, Pathan I, Koliath S. Reconstruction of Defects Following Excision of Basal Cell Carcinoma of Face: A Subunit-based Algorithm. J Cutan Aesthet Surg 2023; 16:1-13. [PMID: 37383975 PMCID: PMC10298610 DOI: 10.4103/jcas.jcas_87_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Introduction Basal cell carcinoma (BCC) is a locally invasive, slowly spreading tumor arising in the basal layer of epidermis and rarely metastasizes. Surgical excision with adequate margins is curative. Reconstruction of post-excisional defects on the face is both essential and challenging. Clinical Cases and Methods A retrospective review of hospital records for patients operated for BCC of the face excluding the pinna at our institute in the last 3 years was done and a review of the literature was carried out to identify the most common principles governing the optimal reconstruction of post-excisional defects on the face. Literature search was made in Embase, Medline, and Cochrane databases in the last two decades with the filters placed for human and English language studies with the search terms (Facial Basal cell carcinoma) AND reconstruction AND (Humans[Mesh]). Results Records of 32 patients with facial BCC who underwent excision and reconstruction at our hospital were identified and details were recorded. Our literature search with the terms and filters mentioned above revealed 244 studies with duplicates removed. After further hand-searching, 218 journal articles were identified, reviewed, and a reconstruction algorithm was designed based on the findings. Discussion Reconstruction of post-BCC excisional defects of the face relies on an adequate understanding of the general principles of reconstruction, subunit principle of facial esthetics, flap anatomy and vascularity as well as operator experience. Complex defects need innovative solutions, multidisciplinary approaches, and newer methods of reconstruction like perforator flaps and newer techniques like supermicrosurgery. Conclusion Multiple reconstructive options for post-excisional defects of the BCC over the face are available and most defects can be approached in an algorithmic manner. Further well-designed prospective research studies are needed to compare outcomes of different reconstructive options for a given defect and identify the most suitable options.
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Affiliation(s)
- Devi Prasad Mohapatra
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - M T Friji
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - S Dinesh Kumar
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ravi Kumar Chittoria
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Imran Pathan
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Shijina Koliath
- Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Gjorup CA, Moeller MP, Asklund C, Hölmich LR, Breiting LB. Versatility of composite grafts for nasal defects – a case series. Case Reports Plast Surg Hand Surg 2022; 9:236-248. [PMCID: PMC9718562 DOI: 10.1080/23320885.2022.2140665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This retrospective study describes the reconstruction of 18 nasal defects with chondrocutaneous (composite) grafts. Composite grafts are versatile one-stage options for defects ≤2.5 cm at the lower third of the nose and are particularly useful in reconstruction of small full-thickness defects and superficial defects bordering or involving the alar rim.
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Affiliation(s)
- Caroline Asirvatham Gjorup
- Department of Plastic Surgery, Copenhagen University Hospital, Herlev, Denmark,CONTACT Caroline Asirvatham Gjorup Department of Plastic Surgery, Copenhagen University Hospital, Herlev, Denmark
| | | | - Camilla Asklund
- Department of Plastic Surgery, Copenhagen University Hospital, Herlev, Denmark
| | | | - Line Bro Breiting
- Department of Plastic Surgery, Copenhagen University Hospital, Herlev, Denmark
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12
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Mamsen FPW, Kiilerich CH, Hesselfeldt-Nielsen J, Saltvig I, Remvig CL, Trøstrup H, Schmidt VJ. Risk Stratification of Local Flaps and Skin Grafting in Skin Cancer-Related Facial Reconstruction: A Retrospective Single-Center Study of 607 Patients. J Pers Med 2022; 12. [PMID: 36556287 DOI: 10.3390/jpm12122067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/10/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient’s tumor size and location allow for both procedures.
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Vyas K, Suchyta M, Gibreel W, Martinez-Jorge J, Bite U, Sharaf BA, Bradley EA, Amer H, Bakri K, Mardini S. Virtual Surgical Planning and 3D-Printed Surgical Guides in Facial Allotransplantation. Semin Plast Surg 2022; 36:199-208. [PMID: 36506279 PMCID: PMC9729061 DOI: 10.1055/s-0042-1756452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The complex three-dimensional (3D) anatomy in facial allotransplantation creates a unique challenge for surgical reconstruction. Evolution of virtual surgical planning (VSP) through computer-aided design and computer-aided manufacturing has advanced reconstructive outcomes for many craniomaxillofacial indications. Surgeons use VSP, 3D models, and surgical guides to analyze and to trial surgical approaches even prior to entering the operating room. This workflow allows the surgeon to plan osteotomies and to anticipate challenges, which improves surgical precision and accuracy, optimizes outcomes, and should reduce operating room time. We present the development, evolution, and utilization of VSP and 3D-printed guides in facial allotransplantation at our institution, from guide conception to first clinical case.
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Affiliation(s)
- Krishna Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marissa Suchyta
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Uldis Bite
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Basel A. Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth A. Bradley
- Division of Oculoplastic Surgery, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Samir Mardini, MD Division of Plastic Surgery, Department of Surgery, Obaid Center for Reconstructive Transplant SurgeryMayo Clinic, MA12-44W, 200 First Street SouthwestRochester, MN 55905
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14
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Vyas KS, Suchyta MA, Hunt CH, Gibreel W, Mardini S. Black Bone MRI for Virtual Surgical Planning in Craniomaxillofacial Surgery. Semin Plast Surg 2022; 36:192-198. [PMID: 36506277 PMCID: PMC9729059 DOI: 10.1055/s-0042-1756451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in computer-aided design and computer-aided manufacturing software have improved translational applications of virtual surgical planning (VSP) in craniomaxillofacial surgery, allowing for precise and accurate fabrication of cutting guides, stereolithographic models, and custom implants. High-resolution computed tomography (CT) imaging has traditionally been the gold standard imaging modality for VSP in craniomaxillofacial surgery but delivers ionizing radiation. Black bone magnetic resonance imaging (MRI) reduces the risks related to radiation exposure and has comparable functionality when compared with CT for VSP. Our group has studied the accuracy of utilizing black bone MRI in planning and executing several types of craniofacial surgeries, including cranial vault remodeling, maxillary advancement, and mandibular reconstruction using fibular bone. Here, we review clinical applications of black bone MRI pertaining to VSP and three-dimensional (3D)-printed guide creation for craniomaxillofacial surgery. Herein, we review the existing literature and our institutional experience comparing black bone MRI and CT in VSP-generated 3D model creation in cadaveric craniofacial surgeries including cranial vault reconstruction, maxillary advancement, and mandibular reconstruction with fibular free flap. Cadaver studies have demonstrated the ability to perform VSP and execute the procedure based on black bone MRI data and achieve outcomes similar to CT when performed for cranial vault reshaping, maxillary advancement, and mandibular reconstruction with free fibula. Limitations of the technology include increased time and costs of the MRI compared with CT and the possible need for general anesthesia or sedation in the pediatric population. VSP and 3D surgical guide creation can be performed using black bone MRI with comparable accuracy to high-resolution CT scans in a wide variety of craniofacial reconstructions. Successful segmentation, VSP, and 3D printing of accurate guides from black bone MRI demonstrate potential to change the preoperative planning standard of care. Black bone MRI also reduces exposure to ionizing radiation, which is of particular concern for the pediatric population or patients undergoing multiple scans.
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Affiliation(s)
- Krishna S. Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marissa A. Suchyta
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota,Department of Radiology, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Samir Mardini, MD Division of Plastic Surgery, Department of Surgery, Essam and Dalal Obaid Center for Reconstructive Transplant SurgeryMayo Clinic, MA12-44W, 200 First Street SouthwestRochester, MN 55905
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15
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Xie Y, Chen Q, Li T, Ding X, Xiao J, Liu Y, Qiu L. Surgical management of facial congenital melanocytic nevi: Experiences and outcomes at an academic center. J Cosmet Dermatol 2022; 21:5811-5818. [PMID: 35593524 DOI: 10.1111/jocd.15104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 05/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Congenital melanocytic nevi (CMN), benign pigmented birthmarks caused by the mutation of melanocytic cells during embryofetal development, can cause aesthetic problem when it is located on the face. Surgical managements of facial CMN are required by both pediatric patients and their parents. Surgical management, including excision or staged excision, skin grafting, dermabrasion, tissue expansion or multiple re-expansion combined with flaps transplantation, have been reported previously. However, a systematical report about facial CMN management is still scarce. OBJECTIVE Herein, we have reviewed our serious of patients with facial CMN, noting their size, location, and histological examination, summarizing the surgical relation behind reconstructive and cosmetic treatment, and proposing a newly classification for facial CMN among pediatric patients, hoping to share a useful surgical algorithm for these lesions on this specific part. CONCLUSION Proper surgical strategy should be made based on the size and location of the nevi and the adjacent relationship between the location and relaxed skin tension lines and aesthetic units. Postoperative ant-scar treatment improves aesthetic outcomes. With our experience and surgical algorithm about facial CMN surgery, a favorable outcome can be achieved.
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Affiliation(s)
- Yue Xie
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Qiang Chen
- Department of Paediatrics Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tianwu Li
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Xionghui Ding
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Jun Xiao
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Yan Liu
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Lin Qiu
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
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16
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Plutecki D, Bonczar M, Ostrowski P, Canon R, Dziedzic M, Zamojska I, Walocha J, Koziej M. The divided zygoma: a meta-analysis of its prevalence with a review of the literature. Folia Morphol (Warsz) 2022; 82:478-486. [PMID: 35916380 DOI: 10.5603/fm.a2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Divided zygoma (DZ) is an important structure in the midfacial region. The anatomy of DZ is poorly researched, but knowledge about this entity could be useful during posttraumatic facial reconstructions. The aim of this study was to estimate the prevalence and anatomy of DZ in different regions around the world. Therefore, the authors performed a meta-analysis, including all studies that report extractable data on the DZ. MATERIALS AND METHODS The main online medical databases such as PubMed, EBSCO, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect, Korean Journal Database and Russian Citation Index, were utilised to gather all studies on anatomical characteristics, prevalence, symmetry, and a number of divisions of zygomatic bone. RESULTS A total of 20 studies were included in this meta-analysis. Data were grouped and analysed in five categories: (1) prevalence of DZ bone, (2) prevalence of DZ skulls, (3) gender prevalence of DZ with sides, (4) divisions of zygomatic bone, (5) symmetry of DZ. CONCLUSIONS In conclusion, the authors of the present study believe that this study can be considered an up-to-date meta-analysis regarding the prevalence, divisions, and symmetricity of the DZ. The data provided by the present study may be useful information for physicians in recognizing the DZ of the fracture and may be important information during zygomatic bone osteotomy. Detailed anatomical knowledge of the midfacial region can prevent surgical complications when operating in this area.
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Affiliation(s)
- D Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - M Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - P Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - R Canon
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - I Zamojska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - J Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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Navic P, Palee P, Prapayasatok S, Prasitwattanaseree S, Sinthubua A, Mahakkanukrauh P. The development and testing of Thai facial soft tissue thickness data in three-dimensional computerized forensic facial reconstruction. Med Sci Law 2022; 62:113-123. [PMID: 34825605 DOI: 10.1177/00258024211057689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Forensic facial reconstruction is a useful tool to assist the public in recognizing human remains, leading to positive forensic investigation outcomes. To reproduce a virtual face, facial soft tissue thickness is one of the major guidelines to reach the accuracy and reliability for three-dimensional computerized facial reconstruction, a method that is making a significant contribution to improving forensic investigation and identification. This study aimed to develop a facial soft tissue thickness dataset for a Thai population, and test its reliability in the context of facial reconstruction. Three-dimensional facial reconstruction was conducted on four skulls (2 males and 2 females, with ages ranging between 51 to 60 years). Two main tools of three-dimensional computer animation and modeling software-Blender and Autodesk Maya-were used to rebuild the three-dimensional virtual face. The three-dimensional coordinate (x, y, z) cutaneous landmarks on the mesh templates were aligned homologous to the facial soft tissue thickness markers on the three-dimensional skull model. The final three-dimensional virtual face was compared to the target frontal photograph using face pool comparison. Four three-dimensional virtual faces were matched at low to moderate levels, ranging from 30% to 70% accuracy. These results demonstrate that the facial soft tissue thickness database of a Thai population applied in this study could be useful for three-dimensional computerized facial reconstruction purposes.
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Affiliation(s)
- Pagorn Navic
- PhD Program in Anatomy, Faculty of Medicine, 26682Chiang Mai University, Thailand
- Department of Anatomy, Faculty of Medicine, 26682Chiang Mai University, Thailand
| | - Patison Palee
- College of Arts, Media and Technology, 26682Chiang Mai University, Thailand
| | - Sangsom Prapayasatok
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, 26682Chiang Mai University, Thailand
| | | | - Apichat Sinthubua
- Department of Anatomy, Faculty of Medicine, 26682Chiang Mai University, Thailand
- Excellence Center in Osteology Research and Training Center, 26682Chiang Mai University, Thailand
- Forensic Osteology Research Center, Faculty of Medicine, 26682Chiang Mai University, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, 26682Chiang Mai University, Thailand
- Excellence Center in Osteology Research and Training Center, 26682Chiang Mai University, Thailand
- Forensic Osteology Research Center, Faculty of Medicine, 26682Chiang Mai University, Thailand
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18
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Knott PD, Alemi SA, Han M, Seth R, Park AM, Heaton CM, Grekin RC, Arron ST, Neuhaus I, Yu SS, Saylor DK, Zhu BZ. Skin Color Match in Head and Neck Reconstructive Surgery. Laryngoscope 2021; 132:1753-1759. [PMID: 34904721 DOI: 10.1002/lary.29959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium. STUDY DESIGN Cross sectional photographic study of reconstructed facial skin color match. METHODS Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed. RESULTS The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient = 0.80. CONCLUSIONS On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Philip Daniel Knott
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Sean A Alemi
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Mary Han
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Rahul Seth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Andrea M Park
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Roy C Grekin
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Isaac Neuhaus
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Siegrid S Yu
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Drew K Saylor
- Department of Dermatology, University of California, San Francisco, California, U.S.A
| | - Bovey Z Zhu
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
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Khetpal S, Sasson DC, Lopez J, Steinbacher DM, Gosain AK. The Impact of Social Determinants of Health in Facial and Craniomaxillo facial Reconstruction: Can We Do Better? Cleft Palate Craniofac J 2021; 59:938-945. [PMID: 34514875 DOI: 10.1177/10556656211037510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients' education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.
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Affiliation(s)
| | - Daniel C Sasson
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Joseph Lopez
- 12228Yale School of Medicine, New Haven, CT, USA
| | | | - Arun K Gosain
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
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20
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Jessop ZM, Hague A, Dobbs TD, Stewart KJ, Whitaker IS. Facial Cartilaginous Reconstruction-A Historical Perspective, State-of-the-Art, and Future Directions. Front Surg 2021; 8:680186. [PMID: 34485372 PMCID: PMC8415446 DOI: 10.3389/fsurg.2021.680186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Importance: Reconstruction of facial deformity poses a significant surgical challenge due to the psychological, functional, and aesthetic importance of this anatomical area. There is a need to provide not only an excellent colour and contour match for skin defects, but also a durable cartilaginous structural replacement for nasal or auricular defects. The purpose of this review is to describe the history of, and state-of-the-art techniques within, facial cartilaginous surgery, whilst highlighting recent advances and future directions for this continually advancing specialty. Observations: Limitations of synthetic implants for nasal and auricular reconstruction, such as silicone and porous polyethylene, have meant that autologous cartilage tissue for such cases remains the current gold standard. Similarly, tissue engineering approaches using unrelated cells and synthetic scaffolds have shown limited in vivo success. There is increasing recognition that both the intrinsic and extrinsic microenvironment are important for tissue engineering and synthetic scaffolds fail to provide the necessary cues for cartilage matrix secretion. Conclusions and Relevance: We discuss the first-in-man studies in the context of biomimetic and developmental approaches to engineering durable cartilage for clinical translation. Implementation of engineered autologous tissue into clinical practise could eliminate donor site morbidity and represent the next phase of the facial reconstruction evolution.
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Affiliation(s)
- Zita M. Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Adam Hague
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Thomas D. Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Kenneth J. Stewart
- Department of Plastic and Reconstructive Surgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Iain S. Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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21
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Montorfano L, Bordes SJ, Sarmiento Cobos M, Garcia Lopez EA, Medina M. Use of Indocyanine Green Angiography for Real-Time Assessment of a Sternocleidomastoid Muscle Flap During Complex Facial Reconstruction. Cureus 2021; 13:e13970. [PMID: 33884231 PMCID: PMC8054840 DOI: 10.7759/cureus.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Indocyanine green (ICG) angiography is a procedure that uses a fluorescent dye for a variety of medical diagnostics, including the real-time examination of blood flow in tissue. Herein, we report a case in which ICG angiography was used to assess the viability of a sternocleidomastoid (SCM) muscle flap during post-parotidectomy facial reconstruction. To our knowledge, this is the first report documenting the intraoperative use of ICG for the evaluation of SCM flap perfusion. ICG angiography may prove beneficial for cases involving complex reconstructions and suspected organ hypoperfusion.
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Affiliation(s)
| | - Stephen J Bordes
- Surgical Anatomy, Tulane University School of Medicine, New Orleans, USA
| | | | | | - Michael Medina
- Otolaryngology-Head and Neck Surgery, Cleveland Clinic Florida, Weston, USA
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22
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Sarna K, Amuti T, Butt F, Kamau M, Muriithi A. Variations of the Anatomy and Bony Landmarks of Deep Circumflex Iliac Artery in a Select Kenyan Population. Craniomaxillofac Trauma Reconstr 2021; 13:300-304. [PMID: 33456701 DOI: 10.1177/1943387520958333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The deep circumflex iliac artery (DCIA) is a large caliber artery which branches laterally from the external iliac artery (EIA), directly opposite the origin of the inferior epigastric artery (IEA). Population variations have been reported in its origin, length, and branching patterns. These may alter its relationship to palpable surgical landmarks such as the anterior superior iliac spine (ASIS) and the pubic tubercle (PT) which are used to locate the artery preoperatively, thus predisposing it iatrogenic injury. Despite this, there is paucity of data from the Kenyan setting. Study Design Cross-sectional study design. Objective To determine the variations of the anatomy and bony landmarks of the Deep circumflex iliac artery in a select Kenyan population. Methods A total of 104 DCIA from 52 formalin fixed adult cadavers were dissected to expose the DCIA, following which its vessel of origin and distance from the ASIS and PT, relation to the inguinal ligament (IL), length and branching patterns were noted. The average of the measurements were calculated. All data were collected and analyzed using Microsoft Excel 2007 (Microsoft Corporation, Redmond, WA). Representative photos of the vessel and its variations were taken. Results The DCIA was found to be present and bilaterally symmetrical in all cadavers. In all cases observed, it originated as a lateral branch from the EIA (100%), opposite the IEA and directly behind the IL in 98% of the cases. Its average distance from the ASIS along the IL was 7.28 ± 0.99, while it was 5.91 ± 1.03 from the pubic tubercle to its origin. Its length ranged from 3.7 cm to 9.5 cm, with an average length of 3.86 cm in the right limb and 3.67 cm in the left limb. As regards its branching patterns, in 78% of the cases, it bifurcated into the horizontal and ascending branches, in 6%, it trifurcated and in 4%, it divided into more than 3, exhibiting a fine tree-like branching (arborization). Conclusion The DCIA in our setting exhibited variations from other settings and an increase in awareness of these variations will probably reduce future iatrogenic lesions of the DCIA and its major branches in Kenya.
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Affiliation(s)
- Krishan Sarna
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Thomas Amuti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Fawzia Butt
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Martin Kamau
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Anne Muriithi
- Department of Human Physiology, University of Nairobi, Nairobi, Kenya
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Kuhlmann C, Schenck TL, Tluczynski K, Aszodi A, Metzger P, Giunta R, Wiggenhauser PS. Experimental approach to nasal septal cartilage regeneration with adipose tissue-derived stem cells and decellularized porcine septal cartilage. Xenotransplantation 2020; 28:e12660. [PMID: 33350016 DOI: 10.1111/xen.12660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cartilage shortage is a major problem in facial reconstructive surgery. Prior studies have shown that decellularized porcine nasal septal cartilage (DPNC) seeded with primary human nasal chondrocytes enabled cartilage regeneration and showed potential as a replacement material for nasal cartilage. Since adipose tissue-derived stem cells (ASCs) are easily accessible and almost abundantly available, they appear to be a promising alternative to limited chondrocytes making the combination of DPNC and ASCs a feasible approach towards clinical translation. Thus, this study was intended to investigate the interactions between ASCs and DPNC in an in vitro model. METHODS DPNCs were seeded and 3D-cultured with primary human ASCs that were priorly characterized with trilineage differentiation and flow cytometry. Cell vitality and proliferation were evaluated by Live-Dead, alamarBlue, and PicoGreen assays. Chondrogenic differentiation was examined by DMMB assay and cryosectioning-based histology. Cell invasion within DPNC was visualized and quantified by fluorescent histology (DAPI, Phalloidin). RESULTS ASCs showed good adherence to DPNC and Live-Dead assay proved their viability over 2 weeks. AlamarBlueassay showed an increase in metabolic activity compared to 2D cultures, and PicoGreen assay demonstrated an increase of cell number within DPNC over time. Biochemical assays and histology added evidence of chondrogenic differentiation of 3D-cultured ASCs under the influence of chondrogenic induction medium. Fluorescent image analysis showed a significant increase of cell-occupied areas of scaffolds over time (P < .05). CONCLUSIONS DPNC scaffolds provided a suitable environment for ASCs that allowed good cell vitality, high proliferation, and chondrogenic differentiation. Thus, the use of ASCs and DPNC yields a promising alternative to the use of primary human chondrocytes. For facial cartilage tissue engineering, we regard ASCs as an attractive alternative to human nasal chondrocytes due to their better accessibility and availability. Further research will be necessary to determine long-term effects and in vivo outcomes of ASCs and DPNC in cartilage regeneration of the face.
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Affiliation(s)
- Constanze Kuhlmann
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany.,Laboratory of Experimental Surgery and Regenerative Medicine, Clinic for General, Trauma and Reconstructive Surgery, Klinikum der Universität München, Martiensried, Germany
| | - Thilo Ludwig Schenck
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
| | - Katharina Tluczynski
- Institute of Bioprocess Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Attila Aszodi
- Laboratory of Experimental Surgery and Regenerative Medicine, Clinic for General, Trauma and Reconstructive Surgery, Klinikum der Universität München, Martiensried, Germany
| | - Philipp Metzger
- Division of Clinical Pharmacology and Center of Integrated Protein Science Munich (CIPSM), Klinikum der Universität München, Munich, Germany
| | - Riccardo Giunta
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
| | - Paul Severin Wiggenhauser
- Department of Hand Surgery, Plastic Surgery, Aesthetic Surgery, Klinikum der Universität München, Munich, Germany
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Kwan Z, Khairu Najhan NN, Yau YH, Luximon Y, M Nor F. Anticipating local flaps closed-form solution on 3D face models using finite element method. Int J Numer Method Biomed Eng 2020; 36:e3390. [PMID: 32735083 DOI: 10.1002/cnm.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/11/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
A realistic three-dimensional (3D) computational model of skin flap closures using Asian-like head templates from two different genders, male and female, has been developed. The current study aimed to understand the biomechanics of the local flap designs along with the effect of wound closures on the respective genders. Two Asian head templates from opposite genders were obtained to use as base models. A third-order Yeoh hyperelastic model was adapted to characterize as skin material properties. A single layer composed of combined epidermis and dermis was considered, and the models were thickened according to respective anatomical positions. Each model gender was excised with a fixed defect size which was consequently covered by three different local flap designs, namely advancement, rotation, and rhomboid flaps. Post-operative simulation presented various scenarios of skin flap closures. Rotation and rhomboid flaps demonstrated maximal tension at the apex of the flap for both genders as well as advancement flap in the female face model. However, advancement flap closure in the male face model was presented otherwise. Yet, the deformation patterns and the peak tension of the discussed flaps were consistent with conventional local flap surgery. Moreover, male face models generated higher stresses compared to the female face models with a 70.34% mean difference. Overall, the skin flap operations were executed manually, and the designed surgery model met the objectives successfully while acknowledging the study limitations. NOVELTY FILE: 3D head templates were considered to address the gap as 3D face models were uncommonly employed in understanding the biomechanics of the local flaps realistically. Most of the existing studies focus on the 2D and 3D planar geometry in their models. As gender comparison has yet to be addressed, we intended to fill this gap by exploring the stress contours of the local flap designs in different genders. Create a 3D face model from two opposite genders which is capable of simulating closure of wounds using local flaps with a focus on advancement, rotation, and rhomboid flaps.
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Affiliation(s)
- Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | | | - Yat Huang Yau
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - Yan Luximon
- School of Design, The Hong Kong Polytechnic University, Hong Kong
| | - Fethma M Nor
- Department of Mechanical Engineering, Curtin University, Malaysia
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Baldasso RP, Moraes C, Gallardo E, Stumvoll MB, Crespo KC, Strapasson RAP, de Oliveira RN. 3D forensic facial approximation: Implementation protocol in a forensic activity. J Forensic Sci 2020; 66:383-388. [PMID: 33027540 DOI: 10.1111/1556-4029.14587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three-dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open-source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests-which are considered costly for the State or Federation-and consequently reducing the waiting time before delivery of the body to its family.
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Affiliation(s)
- Rosane Pérez Baldasso
- Forensic Expert, Department of Criminalistics, Department of Forensic Medicine, General Institute of Forensic Expertises, State Public Safety Office, Rio Grande do Sul, Brazil.,Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Elisa Gallardo
- Forensic Expert, Department of Forensic Medicine, General Institute of Forensic Expertises, State Public Safety Office, Rio Grande do Sul, Brazil
| | - Monica Bujes Stumvoll
- Forensic Expert, Department of Forensic Medicine, General Institute of Forensic Expertises, State Public Safety Office, Rio Grande do Sul, Brazil
| | - Kleber Cardoso Crespo
- Forensic Expert, Department of Forensic Medicine, General Institute of Forensic Expertises, State Public Safety Office, Rio Grande do Sul, Brazil
| | - Raíssa Ananda Paim Strapasson
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
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26
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Guo P, Pan B, He L, Jiang H, Yang Q, Lin L. Application of the Expanded Neck Flap for Face and Ear Reconstruction in Burn Patients: A Report on 2 Cases. Ear Nose Throat J 2020; 101:449-453. [PMID: 33023339 DOI: 10.1177/0145561320963592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reconstruction of auricular deformities and facial scars after burns is a challenging undertaking for surgeons. Excessive scar tissue, a poor blood supply and the paucity of available skin are all substantial difficulties that should be considered before the operation. Expanded neck flaps provide comparatively larger and thinner flaps for the simultaneous treatment of auricular deformities and facial scars in burn patients. In this article, the authors introduced the use of an expanded neck flap as coverage tissue for ear reconstruction and face resurfacing in 2 burn patients. The operation consisted of 3 stages. In the first stage, the expander was implanted subcutaneously under the skin of the neck to create adequate skin and soft tissue. In the second stage, the expander was removed, and the expanded flap was transferred to cover defects on the auricle and face. The third operation to repair the reconstructed ear and thick flap could be performed according the willingness of the patients and surgeons. Esthetically satisfactory results were achieved in both of the patients. The flaps survived completely, and the skin color, texture, and flexibility were well matched to those of the peripheral tissue. Six months postoperatively, the flaps did not shrink, and subsequent contractures did not recur. Both of the patients experienced high satisfaction, and no adverse effects were detected.
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Affiliation(s)
- Peipei Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, China
| | - Bo Pan
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leren He
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Yang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Lin
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Bertasi TGO, Bertasi RAO, Gruenbaum SE, Rodrigues ES. Induction of General Anesthesia and Mask Ventilation With a Full-Face Continuous Positive Airway Pressure Mask in a Patient With a Nose Deformity. Cureus 2020; 12:e9475. [PMID: 32874804 PMCID: PMC7455461 DOI: 10.7759/cureus.9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mask ventilation (MV) is an essential component of airway management and can be lifesaving in situations where the placement of a secure airway device proves challenging. Effective MV requires a seal to be created between the mask and the face to maintain patency of the external airway structures and can be difficult in the setting of facial abnormalities or facial trauma. Here we describe a case in which a continuous positive airway pressure (CPAP) mask was used for anesthesia induction and MV in an 85-year-old man who underwent a plastic surgery reconstruction of the left nasal dorsum and ala following a Mohs surgery, which had prevented the use of conventional face mask. An effective seal was achieved, and anesthesia was successfully induced with the mask. We reviewed the literature and discussed alternative approaches for face mask use in the setting of facial abnormalities where the use of a conventional mask is unfeasible.
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Affiliation(s)
- Tais G O Bertasi
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Shaun E Gruenbaum
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
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28
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Ganry L, Ettinger KS, Rougier G, Qassemyar Q, Fernandes RP. Revisiting the temporal artery posterior auricular skin flap with an anatomical basis stepwise pedicle dissection for use in targeted facial subunit reconstruction. Head Neck 2020; 42:3153-3160. [PMID: 32686883 DOI: 10.1002/hed.26362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/26/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small- to medium-sized facial subunit defects. METHODS Twenty-six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen. RESULTS The pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications. CONCLUSION The pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction.
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Affiliation(s)
- Laurent Ganry
- Faculté de Médecine, Sorbonne Université, Paris, France.,Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France
| | - Kyle S Ettinger
- Section of Head and Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, Minnesota, USA
| | - Guillaume Rougier
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France.,Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Quentin Qassemyar
- Faculté de Médecine, Sorbonne Université, Paris, France.,Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France
| | - Rui P Fernandes
- Head and Neck Oncologic Surgery and Microvascular Fellowship Program, Division of Head and Neck Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.,Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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Matsumoto A, Nijhawan RI. Using a Mustarde-like backcut to maximize crescentic advancement flaps for large nasomalar defects. J Am Acad Dermatol 2020; 86:e261-e262. [PMID: 32682886 DOI: 10.1016/j.jaad.2020.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Andrew Matsumoto
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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30
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Budihardja AS, Lutfianto B, Liman NP, Hiesmantjaja H, Wolff KD. Rare Facial Cleft: Surgical Treatment and Middle-Term Follow-up During Charity Operation. Craniomaxillofac Trauma Reconstr 2020; 13:138-142. [PMID: 32642046 DOI: 10.1177/1943387520904210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Facial cleft is a rare and challenging craniofacial malformation. Treatment of rare facial cleft is complex, and the evaluation of its long-term results is challenging because of the low incidence. In this article, we would like to present middle-term follow-up of 6 patients with facial cleft Tessier number 4, number 5, and number 7 who were treated in our center during charity surgical mission. We will discuss surgical option, difficulties, and complication that may arise in this surgery.
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Affiliation(s)
- Andi Setiawan Budihardja
- Department of Oral and Maxillofacial Surgery, Siloam Hospital Lippo Village, University of Pelita Harapan, Jakarta, Indonesia
| | - Bakhrul Lutfianto
- Department of Oral and Maxillofacial Surgery, Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität, München, Germany
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31
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Camison L, Naran S, Lee WW, Grunwaldt LJ, Davit AJ, Goldstein JA, O'Toole KS, Losee JE, Adetayo OA. Hyperbaric Oxygen Therapy for Large Composite Grafts: An Alternative in Pediatric Facial Reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:2178-2184. [PMID: 32553822 DOI: 10.1016/j.bjps.2020.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 04/24/2020] [Accepted: 05/09/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Management of pediatric facial defects can be challenging, as reattachment of large composite grafts is usually unsuccessful. Hyperbaric oxygen therapy (HBO) has been researched to augment composite graft survival, but clinical use for this application remains anecdotal. The authors present their successful experience managing select cases with large composite grafts and HBO as an adjunct. METHODS A retrospective chart review identified children presenting with facial defects and managed operatively with large composite grafts (≥1.5 × 1.5 cm) and HBO therapy. Records were reviewed for defect characteristics, management details, and outcomes at last follow-up. RESULTS Nine children (avg. 8.4 years, range 1.6-15.1) presented with ear or nose defects secondary to dog bites (n=7), falls (n=1), or congenital causes (n=1). Three experienced ear amputations, and six suffered nasal avulsions of varying degrees. All avulsed ears were reattached. Three cases of nose avulsions were reattached; the other three underwent secondary reconstruction with composite ear grafts. HBO was initiated immediately and continued for 8-10 days. All grafts survived at least 80% with no postoperative complications. At last follow-up (avg. 30.1 months; 0.8-63.9), all patients demonstrated good cosmetic results with minimal residual deformity. CONCLUSION When reconstruction of pediatric facial defects warrants a large chondrocutaneous graft, immediate postoperative HBO therapy can increase survival. Particularly when reattaching amputated segments, if successful, this approach offers an anatomically ideal result without donor site morbidity. If unsuccessful, it does not "burn bridges" and decreases the extent of secondary reconstruction. The authors present their HBO protocol along with a review of available literature.
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Affiliation(s)
- Liliana Camison
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania.
| | - Sanjay Naran
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania; Division of Pediatric Plastic Surgery, Advocate Healthcare Hospital. Park Ridge, Illinois; Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences. Chicago, Illinois
| | - Wei-Wei Lee
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania
| | - Lorelei J Grunwaldt
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania
| | - Alexander J Davit
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania
| | - Jesse A Goldstein
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania
| | - Kevin S O'Toole
- Department of Emergency Medicine, University of Pittsburgh Medical Center. Pittsburgh, Pennsylvania
| | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania
| | - Oluwaseun A Adetayo
- Division of Plastic Surgery, Section of Pediatric Plastic Surgery. Albany Medical Center and Bernard and Millie Duker Children's Hospital at Albany Medical Center. Albany, New York
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Abstract
Maxillary defects commonly present following surgical resection of oncologic processes. The use of rotational and free flaps has largely replaced the use of prosthetic options for hard palate and maxillary reconstruction, but prostheses remain a useful tool. Prosthetic devices may be invaluable in patients considered poor candidates for surgical reconstruction secondary to poor vascularity, need for postoperative radiation, or medical comorbidities that place them at high risk for healing following reconstruction. Obturators may also be considered over soft tissue options if oncologic surveillance via direct visualization of the surgical site is warranted.
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Affiliation(s)
- Christopher Pool
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Aurora Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Karapantzou C, Jakob M, Kinney B, Vandeputte J, Vale JP, Canis M. The use of algeness in the face and neck: a safe, alternative filler for cosmetics and reconstruction. Ann Transl Med 2020; 8:362. [PMID: 32355806 PMCID: PMC7186688 DOI: 10.21037/atm.2020.02.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The search for effectiveness and safety in the use of dermal fillers, is an ongoing challenge for aesthetic physicians, plastic surgeons and the science of bioengineering. Understanding the variety of characteristics, capabilities, advantages and disadvantages of available injectables is essential to reduce complication rates and achieve satisfying aesthetic and functional results. Methods Algeness is a 100% natural, biodegradable tissue implant, consisting of a gel derived from agarose. This paper analyzes the use of this newly introduced agarose gel as an alternative filler in the face and neck for aesthetic and functional indications. All participants gave informed consent before taking part and there was no ethics approval required. As this work describes opinions based on clinical experienced physicians and not the results of a monocentric study. Results Algeness is competitive with other available hydrophilic biomaterials, such as hyaluronic acid, and has the advantage of its unique hydrocolloid nature. Conclusions Compared to other injectables, it exhibits good tolerability, excellent persistence, negligible immunological reaction, biocompatibility and maximal safety—all properties combined with immediate volume restoration and predictable outcomes. “What you see (on injection), is what you get (as a result)”. Level of evidence: Level V, opinions based on clinical experience.
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Affiliation(s)
- Chrisanthi Karapantzou
- ORL Clinic, Ludwigs-Maximilians-University Munich, Munich, Germany.,Karapantzou ENT Company, Drama, Greece
| | - Mark Jakob
- ORL Department, Ludwig-Maximilians University Munich, Munich, Germany
| | - Brian Kinney
- University of Southern California, Beverly Hills, USA
| | | | - Joao Pedro Vale
- Plastic Surgery, Bellage Clinic Aesthetic Medicine, Lisbon, Portugal
| | - Martin Canis
- ORL Department, Ludwig-Maximilians University Munich, Munich, Germany
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34
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Fuller AK, McCrary HC, Graham ME, Skirko JR. The Case of the Missing Nose: Congenital Arhinia Case Presentation and Management Recommendations. Ann Otol Rhinol Laryngol 2020; 129:645-648. [PMID: 32100546 DOI: 10.1177/0003489420909415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To discuss the presentation and management of infants with arhinia or congenital absence of the nose. METHODS This case report describes an infant with arhinia that was diagnosed prenatally. In addition to a discussion of the case, a review of the literature was completed to define appropriate postnatal work-up and management. RESULTS The patient is a term male infant, diagnosed with arhinia on ultrasound and magnetic resonance imaging (MRI) performed at 21-weeks gestational age. Upon birth, the patient was subsequently intubated, followed by tracheostomy due to complete nasal obstruction. Through a genetics evaluation, the patient was found to be heterozygous for the SMCHD1 gene, with hypomethylation at the D4Z4 locus. Plans for reconstruction will be based on future imaging and the development of any nasal patency, however, the patient's family plans to utilize a prosthetic nose until the patient is older. CONCLUSION Arhinia is a rare condition causing respiratory distress in the neonatal period. While stabilization of the airway is the first priority, further management is not clearly defined given the rarity of the malformation. This case discusses stabilization of the airway with a review of treatment and reconstructive options.
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Affiliation(s)
- Andrew K Fuller
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hilary C McCrary
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - M Elise Graham
- Department of Otolaryngology, Western University, London, ON, Canada
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
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Kang JM, Kalin-Hajdu E, Idowu OO, Vagefi MR, Kersten RC. Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware. Craniomaxillofac Trauma Reconstr 2020; 13:32-37. [PMID: 32642029 DOI: 10.1177/1943387520906004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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Bejinariu CG, Dragosloveanu CDM, Marinescu SA. Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma. Rom J Ophthalmol 2020; 64:57-61. [PMID: 32292859 PMCID: PMC7141915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion. Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.
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Affiliation(s)
- Cătălin Gheorghe Bejinariu
- Department of Plastic and Reconstructive Surgery, “Bagdasar-Arseni”
Clinical Emergency Hospital, Bucharest, Romania
| | | | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, “Bagdasar-Arseni”
Clinical Emergency Hospital, Bucharest, Romania
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37
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Ciucă A, Grecu A, Ciurea M, Ciucă EM, Sălan AI. Palatal Reconstruction after Major Surgical Excision. Curr Health Sci J 2019; 45:416-8. [PMID: 32110445 DOI: 10.12865/CHSJ.45.04.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/07/2019] [Indexed: 12/03/2022]
Abstract
Oncological excision surgery in the oral and maxillofacial area amputates important structures or open cavities (sinus, nose, mouth) which are usually "closed". The disappearance of an eye, tongue, soft palate or cheek, raises serious issues regarding the resumption of partial or total functions of that region, in terms of social reintegration of the patient. In the cephalic extremity, the reconstruction material is limited, so specialists resort to resources located away from the defect to achieve closure. The temporal flap isn’t used very often, although this procedure has the advantages of a shorter time for surgery and for healing.
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Barbaro F, Consolini E, Toscani G, Zini N, Dallatana D, Setti P, Mosca S, Di Conza G, Bassi E, Quarantini E, Quarantini M, Raposio E, Gorreri M, Porro A, Toni R. The masks of Lorenzo Tenchini: their anatomy and surgical/bioengineering clues. J Anat 2019; 235:1036-1044. [PMID: 31637719 DOI: 10.1111/joa.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/01/2022] Open
Abstract
An academic, anatomist, and Lombrosian psychiatrist active at the University of Parma in Italy at the end of the 19th century, Lorenzo Tenchini produced ceroplastic-like masks that are unique in the anatomical Western context. These were prepared from 1885 to 1893 with the aim of 'cataloguing' the behaviour of prison inmates and psychiatric patients based on their facial surface anatomy. Due to the lack of any reference to the procedure used to prepare the masks, studies were undertaken by our group using X-ray scans, infrared spectroscopy, bioptic sampling, and microscopy analysis of the mask constituents. Results showed that the masks were stratified structures including plaster, cotton gauze/human epidermis, and wax, leading to a fabrication procedure reminiscent of 'additive layer manufacturing'. Differences in the depths of these layers were observed in relation to the facial contours, suggesting an attempt to reproduce, at least partially, the three-dimensional features of the facial soft tissues. We conclude the Tenchini masks are the first historical antecedent of the experimental method for face reconstruction used in the early 2000s to test the feasibility of transferring a complete strip of face and scalp from a deceased donor to a living recipient, in preparation for a complete face transplant. In addition, the layering procedure adopted conceptually mimics that developed only in the late 20th century for computer-aided rapid prototyping, and recently applied to bioengineering with biomaterials for a number of human structures including parts of the skull and face. Finally, the masks are a relevant example of mixed ceroplastic-cutaneous preparations in the history of anatomical research for clinical purposes.
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Affiliation(s)
- Fulvio Barbaro
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Elia Consolini
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Giulia Toscani
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Nicoletta Zini
- CNR - National Research Council of Italy, Institute of Molecular Genetics, Sezione di Bologna, Bologna, Italy.,IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Dallatana
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Pietro Setti
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Salvatore Mosca
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Giusy Di Conza
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Elena Bassi
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | | | - Marco Quarantini
- Medical Center Galliera (CMG), San Venanzio di Galliera (BO), Italy
| | - Edoardo Raposio
- Chair of Plastic Surgery, DIMEC, University of Parma, Parma, Italy
| | - Marina Gorreri
- University of Parma Museum Network (Sistema Museale d'Ateneo), Parma, Italy
| | - Alessandro Porro
- Chair for the History of Medicine, University of Milan, Milan, Italy
| | - Roberto Toni
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy.,Medical Center Galliera (CMG), San Venanzio di Galliera (BO), Italy.,Interdepartment Center for Sport and Exercise Medicine, University of Parma, Parma, Italy.,Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center - Tufts University School of Medicine, Boston, MA, USA
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39
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Wei MZ, Luo QN, Li XS, Yan WJ, Cao HG, Li XA. [To reconstruct facial defects after removing skin lesions by using local flap]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:966-969. [PMID: 31623045 DOI: 10.13201/j.issn.1001-1781.2019.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study is to investigate the method and effect of reconstruction of facial skin defects after removing the lesions by applying local flap. Method:Fifty-three patients (30 males and 23 females) with facial skin lesions. Complete surgical resection of the lesion; malignant tumor resection should be strictly non-tumor principle; intraoperative frozen section pathological examination confirmed negative margin; benign lesions can be cut off the lesion. According to the defect site, the appropriate local flap was used to repair the defect: 13 cases of modified VY propulsion flap, 8 cases of nasolabial flap, 8 cases of A/O-T shaped flap, 6 cases of rotating flap, 5 cases of direct sliding flap, multi-type There were 6 cases with flap, 2 cases with double leaf, 2 cases with prismatic flap and 3 cases with free flap. Result:Patients with malignant tumor were followed for 12-36 months postoperatively while followed for 10-12 months in the benign. Two patients with malignant tumor developed local recurrence and removed again. At half a year after first resection. Distal partial necrosis occurred in 5 cases while the wound dehiscence in1case, others were well developed. No others major complications occurred. Conclusion:There are various types of local skin flap for repairing facial skin defects. It is very important to excise the primary lesion radically before reconstruction,the satisfactory curative effect can be obtained through reasonable design of the flap.
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Affiliation(s)
- M Z Wei
- Department of Otolaryngology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine,Foshan,528200,China
| | - Q N Luo
- Department of Pathology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine
| | - X S Li
- Department of Otolaryngology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine,Foshan,528200,China
| | - W J Yan
- Department of Otolaryngology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine,Foshan,528200,China
| | - H G Cao
- Department of Otolaryngology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine,Foshan,528200,China
| | - X A Li
- Department of Otolaryngology,Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine,Foshan,528200,China
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40
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Badash I, Shauly O, Lui CG, Gould DJ, Patel KM. Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques. Clin Med Insights Ear Nose Throat 2019; 12:1179550619865278. [PMID: 31384136 PMCID: PMC6657122 DOI: 10.1177/1179550619865278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher G Lui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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41
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Paim Strapasson RA, Stocco Baccarin L, Haltenhoff Melani RF. Forensic Facial Reconstruction: A Systematic Review of Nasal Prediction Techniques. J Forensic Sci 2019; 64:1633-1639. [PMID: 31211878 DOI: 10.1111/1556-4029.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/27/2019] [Accepted: 05/22/2019] [Indexed: 12/01/2022]
Abstract
Prediction facial features from the skull are recurring theme on the forensic literature. The nose has been investigated since it has a significant role in facial recognition and the literature shows that there is not an universal method for nasal prediction. This study aimed to conduct a systematic review to analyze what are the most consistent techniques of nasal reconstruction. Primary studies describing or validating nasal reconstruction techniques in adults and published in journals of Forensic Sciences were included in this review. Tedeschi-Oliveira's method positioned nasal tip with acceptable accuracy as Gerasimov's method. The Krogman's and Iscan's technique underestimated nasal projection in North Americans. The Prokopec's and Ubelaker's method obtained accuracy in Caucasoid. George's method presented results similar to reference standard in Caucasoid. In a supplementary way, studies are needed to accurately estimate the nasal width.
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Affiliation(s)
- Raíssa Ananda Paim Strapasson
- Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, 2227 Professor Lineu Prestes Avenue, São Paulo, SP, 05508-000, Brazil
| | - Leandro Stocco Baccarin
- Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, 2227 Professor Lineu Prestes Avenue, São Paulo, SP, 05508-000, Brazil
| | - Rodolfo Francisco Haltenhoff Melani
- Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, 2227 Professor Lineu Prestes Avenue, São Paulo, SP, 05508-000, Brazil
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42
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Strapasson RAP, Costa C, Melani RFH. Forensic Facial Approximation: Study of the Nose in Brazilian Subjects. J Forensic Sci 2019; 64:1640-1645. [PMID: 31150115 DOI: 10.1111/1556-4029.14081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
Forensic facial approximation is an auxiliary method for human identification and allows facial recognition. The midface, that includes the nose, is vital for the recognition of a familiar face. The purpose of this study was to set hard tissue parameters to estimate nasal width, to test the method to estimate nasal width of Brazilians, and to analyze the relationship between nasal profile and facial type. A total of 246 computed tomography scans (183 females and 63 males) of adults were analyzed in Horos. Bone tissue measurements and facial type classification were performed on the skull scan. Nasal profile morphology was accessed through the tool 3D surface rendering. There was a difference around 3 mm from real to predicted nose through the method to estimate nasal width in Brazilians. So, the method may be used in forensic practice. Straight nose was associated with long face type.
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Affiliation(s)
- Raíssa Ananda Paim Strapasson
- Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil
| | - Cláudio Costa
- Department of Stomatology, Faculty of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil
| | - Rodolfo Francisco Haltenhoff Melani
- Department of Social Dentistry, Faculty of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil
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43
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Hughes CD, Dabek RJ, Riesel JN, Baletic N, Chodosh J, Bojovic B. Short Runs for a Long Slide: Principalization in Complex Facial Restoration after Acid Attack Burn Injury. Craniomaxillofac Trauma Reconstr 2019; 12:75-80. [PMID: 30815220 DOI: 10.1055/s-0038-1668511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are responsible for between 2 and 20% of burn injuries seen at burn centers in lower income countries. Women are commonly targeted and the perpetrators are often known to the victims. The combination of a high disease prevalence, limited surgical and anesthetic resources, a vulnerable patient population, and largely disfiguring, nonlethal injuries present unique challenges for the reconstructive surgeon who may not encounter such cases regularly. In this article, we present a case of a 16-year-old female who sustained severe, full-thickness burns to the face including eyelids, neck, abdomen, and upper extremities after an intentional acid attack. She began her treatment course with us approximately 1 year after the injury. The deformities of her oral and periorbital regions presented particularly difficult reconstructive problems, including impending visual loss. Using plastic surgical principalization, we provided our patient adequate restoration of facial form and function through numbers of interventions using fundamental and state-of-the-art techniques.
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Affiliation(s)
- Christopher D Hughes
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Division of Plastic, Reconstructive and Laser Surgery, Shriners Hospitals for Children Boston, Boston, Massachusetts
| | - Robert Jaroslaw Dabek
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Johanna N Riesel
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nemanja Baletic
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James Chodosh
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Branko Bojovic
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Division of Plastic, Reconstructive and Laser Surgery, Shriners Hospitals for Children Boston, Boston, Massachusetts
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44
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Meundi MA, David CM. Application of cone beam computed tomography in facial soft tissue thickness measurements for cranio facial reconstruction. J Oral Maxillofac Pathol 2019; 23:114-121. [PMID: 31110427 PMCID: PMC6503801 DOI: 10.4103/jomfp.jomfp_20_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: The paradigm shift from two- to three-dimensional imaging has marked the beginning of a new era in diagnosis. Newly developed cone-beam computed tomography (CBCT) designed specifically to visualize maxillofacial pathologies is being used in forensic investigations also. Facial reconstruction is a specialized forensic technique to identify the deceased from the unknown skull. It is dependent on population-specific facial soft tissue thicknesses. Aims: This study aims to propose the mean dataset of facial soft tissue thickness for South Indian population by utilizing CBCT. It also aims to evaluate the sex and racial differences in the values if any. Settings and Design: This descriptive study was conducted on CBCT scans of South Indians. Materials and Methods: Eighty CBCT scans of South Indian adults aged 18–80 years were selected. Facial soft tissue thickness measurements at 34 craniometric landmarks were carried out. Statistical Analysis: Descriptive statistics was done. Student's t-test estimated the differences of soft tissue thickness between the sexes; bilateral measurements and also racial differences. Tukey's honest significant difference test was used for multiple comparisons among Indian studies. Results: Males had thicker soft tissue than females in most of the landmarks. Differences in the bilateral soft tissue thicknesses were negligible. Indians had thicker facial tissues than the Koreans and CBCT was found efficient in measuring soft tissue thickness. Conclusion: The present study provides facial soft tissue thickness dataset using CBCT which will be useful in forensic facial reconstructions of South Indian population as well as in maxillofacial and plastic reconstructive surgeries.
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Affiliation(s)
- Manasa Anand Meundi
- Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
| | - Chaya Manoranjini David
- Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
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45
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Rifkin WJ, Bellamy JL, Kantar RS, Farber SJ, Diaz-Siso JR, Brecht LE, Rodriguez ED. Autologous Reconstruction of a Face Transplant Candidate. Craniomaxillofac Trauma Reconstr 2018; 12:150-155. [PMID: 31073366 DOI: 10.1055/s-0038-1675844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/28/2018] [Indexed: 01/05/2023] Open
Abstract
Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach.
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Affiliation(s)
- William J Rifkin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Justin L Bellamy
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Scott J Farber
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - J Rodrigo Diaz-Siso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Lawrence E Brecht
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York.,Jonathan and Maxine Ferencz Advanced Education Program in Prosthodontics, New York University College of Dentistry, New York, New York
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
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46
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Abstract
Decisions about medical and surgical treatment can be complex-even for health care providers, who can struggle with which treatment option to offer their patients. In the current landscape of patient-centric value-based health care, the need for appropriate medical decision making to maximize treatment outcomes is evermore important. Shared decision making is a process in which clinicians and patients make decisions together using the best available evidence while accounting for the patients' values and beliefs. A patient-centered approach has been associated with improved patient satisfaction, clinical outcomes, and patient adherence to treatment. Only by taking a collaborative care approach among patients, physicians, and caregivers can we hope to deliver the best possible care and improve our outcomes for each and every patient.
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Affiliation(s)
- John J Chi
- 1 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
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47
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Abstract
This article presents a new numerical method for facial reconstruction. The problem is the following: given a dry skull, reconstruct a virtual face that would help in the identification of the subject. The approach combines classical features as the use of a skulls/faces database and more original aspects: (1) an original shape matching method is used to link the unknown skull to the database templates; (2) the final face is seen as an elastic 3D mask that is deformed and adapted onto the unknown skull. In this method, the skull is considered as a whole surface and not restricted to some anatomical landmarks, allowing a dense description of the skull/face relationship. Also, the approach is fully automated. Various results are presented to show its efficiency.
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Affiliation(s)
- Maya de Buhan
- Centre national de la recherche scientifique, Unité mixte de recherche 8145, Laboratoire de Mathématiques Appliquées de Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chiara Nardoni
- Sorbonne Universités, UPMC Univ Paris 06, Institut des Sciences du Calcul et des Données, Paris, France
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48
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Allam E, Mpofu P, Ghoneima A, Tuceryan M, Kula K. The Relationship Between Hard Tissue and Soft Tissue Dimensions of the Nose in Children: A 3D Cone Beam Computed Tomography Study. J Forensic Sci 2018; 63:1652-1660. [PMID: 29684936 DOI: 10.1111/1556-4029.13801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/21/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
This study using three-dimensional cone beam computed tomography (CBCT) images of children determined relationships between nasal skeletal and soft tissue measurements and assessed the association with sex, age, and skeletal maturation stage. Following reliability studies, skeletal and soft tissue parameters were measured on coded CBCTs of 73 children (28M:45F;6-13 yoa). Pearson and Mantel correlations were used to analyze associations between skeletal and soft tissues. Partial Mantel correlations were used to study the associations between skeletal and soft tissue, adjusting for sex, age, and skeletal maturation. Linear regression analyses were used to predict soft tissues sizes. Logistic regression was used to study the relationships between soft and skeletal tissue symmetry. Except for nasal aperture width and interalar width, skeletal landmarks best predicted corresponding soft tissue landmarks. Significant positive associations existed between skeletal and soft tissues after adjusting for sex, skeletal maturation, and age. Children's nasal skeletal tissues predicted nasal soft tissue reasonably well.
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Affiliation(s)
- Eman Allam
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN.,Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Philani Mpofu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Ahmed Ghoneima
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN.,Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Dubai, UAE
| | - Mihran Tuceryan
- Department of Computer Sciences, Indiana University, Indianapolis, IN
| | - Katherine Kula
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN
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49
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Aldaadaa A, Owji N, Knowles J. Three-dimensional Printing in Maxillofacial Surgery: Hype versus Reality. J Tissue Eng 2018; 9:2041731418770909. [PMID: 29774140 PMCID: PMC5949934 DOI: 10.1177/2041731418770909] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/25/2018] [Indexed: 12/24/2022] Open
Abstract
Three-dimensional printing technology is getting more attention recently, especially in the craniofacial region. This is a review of literature enlightening the materials that have been used to date and the application of such technology within the scope of maxillofacial surgery.
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Affiliation(s)
| | | | - Jonathan Knowles
- Jonathan Knowles, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London WC1X 8LD, UK.
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50
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Chen C, Patel R, Chi J. Comprehensive Algorithm for Nasal Ala Reconstruction: Utility of the Auricular Composite Graft. Surg J (N Y) 2018; 4:e55-e61. [PMID: 29675473 PMCID: PMC5906130 DOI: 10.1055/s-0038-1639581] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/19/2018] [Indexed: 11/01/2022] Open
Abstract
Defects of the nasal ala are challenging to reconstruct, given its complex three-dimensional structure. Successful repair of these defects needs to provide aesthetic symmetry and preserve nasal function. A wide variety of reconstructive options have been described for nasal ala defects, ranging from skin grafts to locoregional flaps, and also includes the auricular composite graft. However, there are currently no comprehensive guidelines for nasal ala repair, and the versatile role of the auricular composite graft has not been well defined. In this review, we aim to provide a comprehensive algorithm to guide repair of nasal ala defects. Additionally, we compare our experience using the auricular composite graft with the available literature to better define its utility in nasal ala repair.
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Affiliation(s)
- Collin Chen
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - Ruchin Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - John Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology- Head and Neck Surgery, Washington University in Saint Louis School of Medicine, St. Louis, Missouri
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