Search Results (6)

Objective: In this study, we analyzed the existing chin augmentation methods and evaluated the effectiveness of using a subplatysmal fat autograft for augmenting insufficient chin projection. Materials and Methods: From January 2017 to December 2023, we studied 170 patients at the Department of Plastic Surgery, Sechenov First Moscow State Medical University, who presented with insufficient chin projection, localized fat deposits in the cervico-mental area, and age-related changes in the lower third of the face. The patients were divided into two groups: Group 1 (n = 93) consisted of patients who underwent chin augmentation using implants (Silastic, Medpor); Group 2 (n = 77) included patients who underwent medial platysmaplasty and chin augmentation using a fat autograft (subplatysmal autograft). Results: Chin augmentation was performed on all the patients with varying degrees of insufficient chin projection. The mean age was 36.5 ± 2 years. The average follow-up period was 18.9 months (range: 2–45 months). For chin augmentation using implants (Silastic, Medpor), +chin projection increases were observed as follows: 1.1–1.2 cm at 3 months, 0.9–2.3 cm at 6 months, and 0.8–1.7 cm at 12 months. The complications in this group included inflammatory processes in 7 (8%) patients, hematomas in 6 (6%) patients, and contour asymmetry in 13 (14%) patients. In the group that underwent chin augmentation with a subplatysmal fat autograft, the chin projection increased by 0.8–1.2 cm at 3 months, 0.7–1.3 cm at 6 months, and 0.6–1.9 cm at 12 months. The mean age was 38.3 ± 7 years, with an average follow-up of 18.3 months (range: 2–43 months). No infectious–inflammatory complications were observed. Aesthetic complications were noted in 14 (18%) patients. Conclusions: Among the existing methods for chin augmentation, many still consider osseous genioplasty to give more predictable results. However, its traumatic nature and lengthy rehabilitation period prompt surgeons to seek effective yet less invasive alternatives. When selecting a minimally invasive method for chin augmentation, preference is given to fat injections (lipofilling) and intraoperative use of autologous fat grafts. Augmentation using subplatysmal autologous fat grafts is a minimally invasive, safe, predictable, and long-lasting method for chin correction. Full article

Background: Empty nose syndrome (ENS) is a syndrome of paradoxical nasal obstruction that is thought to be mostly caused by inappropriate turbinate procedures. This study aimed to investigate depression- and anxiety-associated psychological symptoms in patients with ENS before and after surgical reconstruction, and to compare them with those of control subjects. Methods: Patients with ENS were prospectively enrolled. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item questionnaire (ENS6Q), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate the participants before and after reconstruction surgery with submucosal Medpor implantation (Stryker, Kalamazoo, MI), as well as control subjects at enrollment. Results: Forty patients with ENS and forty age- and sex-matched controls were recruited. Patients with ENS experienced significant improvement in SNOT-25, ENS6Q, BDI-II, and BAI scores after surgery, but all were significantly greater than those in the control group. Nine patients with ENS (22.5%) had postoperative residual psychological symptoms. Preoperative BDI-II and BAI scores were significant predictors of postoperative residual psychological symptoms. The optimal cut-off value was BDI-II > 28.5 (sensitivity, 77.8%; specificity, 77.4%) in receiver operating characteristic curve analysis. Conclusions: The nasal and psychological evaluations in patients with ENS significantly improved after nasal reconstruction surgery, but both were significantly greater than those in the control group. Identifying individuals who may experience postoperative residual symptoms and providing a multimodal approach, including surgical reconstruction and psychiatric treatment, are suggested. Full article

Inert biomaterials used for auricular reconstruction, which is one of the most challenging and diverse tasks in craniofacial or head and neck surgery, often cause problems such as capsule formation, infection, and skin extrusion. To solve these problems, scaffold consisting of inert biomaterial, high-density polyethylene (Medpor^®) encapsulated with neocartilage, biodegradable poly(DL-lactic-co-glycolic acid) (PLGA) was created using a tissue engineering strategy. PLGA scaffold without Medpor^® was created to serve as the control. Scaffolds were vacuum-seeded with rabbit chondrocytes, freshly isolated from the ear by enzymatic digestion. Then, cell-seeded scaffolds were implanted subcutaneously in the dorsal pockets of nude mice. After 12 weeks, explants were analyzed by histological, biochemical, and mechanical evaluations. Although the PLGA group resulted in neocartilage formation, the PLGA–Medpor^® group demonstrated improved outcome with the formation of well-surrounded cartilage around the implants with higher mechanical strength than the PLGA group, indicating that Medpor^® has an influence on the structural strength of engineered cartilage. The presence of collagen and elastin fibers was evident in the histological section in both groups. These results demonstrated a novel method of coating implant material with engineered cartilage to overcome the limitations of using biodegradable scaffold in cartilage tissue regeneration. By utilizing the patient’s own chondrocytes, our proposed method may broaden the choice of implant materials while minimizing side effects and immune reaction for the future medical application. Full article

Craniofacial microsomia (CFM) is a congenital anomaly with a variable phenotype. The most prominent feature of CFM is a predominantly unilateral hypoplasia of the mandible, leading to facial asymmetry. Even after correction of the midline, there is often a remaining hard- and soft-tissue deficiency over the body of the mandible and cheek on the affected side. This clinical report describes the skeletal augmentation of the mandible with a patient-specific implant to treat residual facial asymmetry in two female patients with unilateral CFM. Good aesthetic results were achieved in both patients treated with either a Medpor or polyetheretherketone implant without complications after a follow-up time of 55 and 30 months, respectively. Full article

The use of a three-dimensional (3-D) model has been well described for craniomaxillofacial reconstruction, especially with the preoperative planning of free fibula flaps. This article reports the application of an innovative 3-D model approach for the calculation of the exact contours, angles, length, and general morphology of a prefabricated MEDPOR 2/3 orbital implant for reconstruction of a suprastructure maxillectomy defect. The 3-D model allowed intraoperative modification of the MEDPOR implant which decreased the risk of iatrogenic harm, contamination while also improving aesthetic results and function. With the aid of preoperative 3-D models, porous polypropylene facial implants can be contoured efficiently intraoperatively to precisely reconstruct complex craniomaxillofacial defects. Full article

The purpose of this retrospective study was to investigate treatment options for orbital floor fractures at a Level 1 Trauma Center in Southern California. A review of 45 cases of isolated orbital floor fractures treated at the University of California at Irvine between February 2004 and April 2007 was done. Patients were retrospectively analyzed for gender, age, mechanism of injury, associated facial injuries, presenting symptoms, method of treatment, and postoperative complications. Thirty-six male patients and nine female patients were treated. Motor vehicle collision (26/45) was the most common cause of injury, and the mean age of the patients was 35.5 years (range: 15–81 years). Ecchymosis surrounding the orbital tissue was the most common presentation (38/45). Diplopia was present in 8 of 45 patients, with 1 patient requiring urgent decompression for retrobulbar hematoma. Forty-three patients underwent surgical repair; 40 underwent transconjunctival approach with lateral canthotomy; 17 underwent reconstruction with porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA, USA); and 26 underwent reconstruction with a titanium mesh plate. Immediate postoperative complications included 12 patients with infraorbital numbness, 3 with diplopia, 1 with cellulitis, and 1 with ectropion with a subcilliary approach. Average timing of surgery of our study was 4.94 days (range, 1–20 days). Orbital floor fracture management has changed significantly over the past few decades with the introduction of new internal fixation methods and new materials for reconstructing orbital floor defects. Recommendations for surgical intervention on orbital floor fractures mostly depend on clinical examination and imaging studies. Consequences of inadequate repair of orbital floor fractures can lead to significant facial asymmetry and visual problems. Both porous polyethylene and titanium plates are effective tools for reconstructing the orbital floor. Our review demonstrates that orbital floor fractures can be repaired safely with minimal postoperative complications and confirms that transconjunctival approach to orbital floor is an effective way for exposure and prevention of ectropion that can be seen with other techniques. Full article