Case report: feminizing the male face

OBJECTIVE

Sex reassignment surgery is accepted in properly planned cases to change facial appearance in accordance with a new gender. Although changing the hairdo or makeup, and depilation, give satisfying cosmetic results in many patients, hard and soft tissue facial surgeries are needed in most cases. Unfortunately, few studies on facial corrections have been published and feminizing a male face is still considered an arbitrary undertaking. We present a useful surgical protocol to feminize the male face.

METHOD

Ten male-to-female transsexuals aged 20 to 32 years (average 23 years) were referred after gender reassigning for facial feminization (1990-2007). Clinical examination of the patients revealed variable degrees of common masculine features such as long square faces, broad chins, excessive projection, frontal bossing, prominent flaring gonial angles, high hairlines, and low-set eyebrows. After complete clinical assessment and paraclinical workup including cephalometry, the patients were admitted for feminizing surgery. The face was outlined in geometric proportions. It was aimed to round the male face using a sequence of staged surgical procedures for both hard and soft tissues.

RESULTS

Ten male patients aged 20 to 32 years (average 23 years) underwent facial feminization using basic surgical guidelines. Various amounts of soft and hard tissue changes were required for individual patients and were tailored for each case according to the preoperative workup and standard parameters.

CONCLUSION

All 10 patients were satisfied with their improvement in appearance; the degree of impact these procedures may have on lifestyle remains to be assessed.

Variable presentations of aneurysmal bone cysts of the jaws: 51 cases treated during a 30-year period

PURPOSE

Our study aimed to assess the clinicohistopathological features of maxillofacial aneurysmal bone cysts (ABCs) to distinguish parameters significant to diagnosis and treatment, adding to the body of literature on the subject.

MATERIALS AND METHODS

Fifty-one patients with maxillofacial ABCs treated during a 30-year period were evaluated. The demographics, histopathological findings, site, age, gender distribution, and types of maxillofacial ABCs were evaluated. The data, therapeutic results, and recurrences were then analyzed.

RESULTS

Fifty-one patients diagnosed and treated for ABCs were studied in our series. These included 29 (56.9%) males and 22 (43.1%) females ranging in age from 7 to 58 years, with a mean age of 19.53 +/- 10.79. More than 3/4 of the lesions involved the mandible. ABCs were significantly more common in the mandible and in the first 2 decades of life (P < .05). The site distribution of the location of ABCs within the arch was about equal. Rapidly growing swelling was a significant clinical feature in the majority of the cases (92.2%). ABCs had variable radiographic presentation, but all were radiolucent. All cases were treated by excision and curettage with 84.4% success in the first operation. Eight patients (15.6%) had recurrences after treatment during the follow-up period (2-30 years).

CONCLUSION

Maxillofacial ABCs are uncommon lesions with variable clinical and histological presentations that often respond to treatment by surgical curettage. Recurrence may be attributed to incomplete removal of the lesion.

Orofacial granulomatosis of the lower lip and cheek: report of a case

Orofacial granulomatosis (OFG) is a granulomatous disease of the orofacial region. This clinicopathological entity describes patients with oral lesions characterized by persistent and/or recurrent labial enlargement, ulcers, and a variety of other orofacial features, which on biopsy have lymphedema and noncaseating granulomas. The cause is idiopathic but appears to represent an abnormal immune reaction. This may be a manifestation of Crohn's disease (CD) since some patients with oral lesions develop typical bowel symptoms of CD in ensuing months to years; tooth-associated infections, sarcoidosis, food or contact allergies, and viruses have also been implicated in causing OFG. Clinical features of OFG are highly variable and sometimes so insidious that signs and symptoms are frequently not severe enough to cause alarm. The lips are most commonly involved and demonstrate a nontender, persistent swelling. Because of the relatively nonspecific clinical findings associated with granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for clinicians. We report a case of OFG of the lower lip and cheek and describe its management to add to the current body of literature on the subject.

Congenital fusion of the maxilla and mandible: brief case report

Congenital fusion of the mandible and maxilla is a rare anomaly usually seen in association with various syndromes. Reports of isolated cases of bony fusion of the jaws are sparse. Only 10 reported cases were found in the literature search. Maxillomandibular fusion restricts mouth opening, causing feeding problems and difficulties in swallowing, respiration, growth, and development, and thus must be treated early. We report a case of congenital fusion of the mandible and maxilla in a 1-year-old boy and describe the clinical features of this anomaly to add to the existing literature on the subject. This is our second encounter of such a case.

A simple technique to facilitate the Le Fort I osteotomy downfracture

In order to mobilize and reposition the maxilla when treating dentofacial deformities, the Le Fort I maxillary osteotomy is commonly used. Like other surgical procedures, this procedure is not without inherent difficulties. At times, it may be difficult to initially mobilize the maxilla after performing the osteotomies. Techniques used to help in the initial mobilization and downfracture of the maxilla from the pterygoid plates include digital pressure to the dentoalveolus, disimpaction forceps, spreaders, and other instruments. These techniques are similar in that they all apply a unidirectional downward vector of force on the maxilla and have various drawbacks. We present a technique that uses a 0.5-mm stainless steel traction wire to facilitate Le Fort I maxillary downfracturing by applying a forward and downward vector of force simultaneously. After vertical downfracture of the maxilla, lateral traction on the wire can be used to complete the pterygomaxillary disjunction. This technique has several advantages and is atraumatic, and requires no special instrumentation; thus, downfracturing of the maxilla is done with relatively little effort and minimal risk.

Rehabilitation of war-injured patients with implants: analysis of 442 implants placed during a 6-year period

PURPOSE

This retrospective study assessed the overall outcome of dental implants used for the rehabilitation of war-injured victims during the 6-year period from 1992 to 1998.

MATERIALS AND METHODS

Seventy-three patients suffering various maxillofacial war injuries were rehabilitated using the Brånemark implant system. A total of 442 implants were placed. The patients ranged from 20 to 61 years of age, with an average age of 32 years. Two hundred fifty implants were placed in previously fractured bone, and 192 were placed in grafted bone, 28 of which were placed at the time of bone grafting. The follow-up period ranged from 12 to 72 months (average, 52 months).

RESULTS

Four hundred sixteen of 442 implants were functional and clinically symptom-free during the follow-up period. Six implants were left uncovered. Twenty implants (seven mandible, 13 maxilla) were lost (4.8%). Eleven of these were in bone grafts, and nine were in previously fractured bone. Thus, the overall success rate for the implants during the follow-up period was 95.2%. The success rate for implants placed in previously fractured, nongrafted bone was 97.6% and 92.7% for those placed in grafted bone. No implants were lost in those cases that underwent simultaneous bone grafting and implant placement. However, thread exposure was more common in these cases.

CONCLUSIONS

The functional results of osseointegrated implants used for rehabilitation of war-injured patients was favorable and comparable to their application in otherwise normal edentulous patients. However, a higher overall failure rate was found with implants placed in the maxilla and those placed in grafted bone. The overall aesthetic results were also less favorable in these cases because of the longer abutments required to fill the interarch space and also the subsequent resorption inherent to grafted bone, which resulted in thread exposure.