Facial Plastic Surgery最新文献

Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.

This study aimed to investigate the impact of three-dimensional (3D) technology on preoperative evaluation for rhinoplasty.A systematic search was conducted on Embase, MEDLINE, and Web of Science. Studies that utilized 3D technology in preoperative assessment for rhinoplasty were included. The primary outcome was surgeon and patient satisfaction. The secondary outcomes included nasal function, cost-efficiency, reoperation rate, precision, and surgical time.Twelve studies (595 patients) were included. Surgeons reported higher satisfaction with 3D approaches based on precision and postoperative results. Patients expressed satisfaction with the 3D approaches due to a better understanding of the procedure and the ability to discuss with the surgeons planning the procedure and participating in postoperative design. The 3D approaches demonstrated higher surgeon satisfaction (mean difference -0.13, 95% confidence interval [CI] -0.20 to -0.06, p = 0.0002), particularly in revision cases, and provided higher precision compared with the two-dimensional (2D) approaches. However, 3D technology was more expensive and not cost-efficient. There were no significant differences in reoperation rate (odds ratio 0.16, 95% CI 0.02-1.36, p = 0.09) and surgical time. Postoperative nasal function showed inconsistent results.3D technology offered higher surgeon satisfaction and increased precision compared with 2D imaging. However, 3D imaging was expensive and not cost-efficient. Reoperation rate and surgical time were comparable, while postoperative nasal function outcomes showed inconsistent results.

Facial palsy describes the denervation of the facial nerve leading to difficulty in facial animation and expression. Facial synkinesis is the result of complex pathological nerve regeneration following damage to the facial nerve axons. Synkinesis in facial palsy can be managed using facial neuromuscular rehabilitation, botulinum toxin neuromodulators, and surgical treatment options. Botulinum toxin A can be used as an adjunct to other treatment options to manage synkinesis. This article will explore the role of botulinum toxin A in the management of synkinesis in facial palsy including the clinical assessment, injection location (muscles targeted), dosages, treatment interval, and long-term results. It will also include surgical management options.

Cervical chondrocutaneous branchial remnants (CCBRs) are rare anomalies found in the neck. These remnants can be easily misdiagnosed due to their low incidence, and they are often associated with other anomalies. Previous studies have reported an association with other anomalies in up to 76% of cases. In this article, the authors present a case series of two patients with bilateral CCBRs and investigate the associated anomalies through a literature review. Patients diagnosed with CCBRs who presented with cervical masses were included. Records were reviewed to investigate factors such as sex, location of the CCBRs, associated anomalies, timing of operations, and cartilage pathology. A surgical excision technique was employed, and the study also included a literature review focusing on reports related to CCBRs and associated anomalies. Two patients, a 3-year-old boy and a 17-year-old adolescent girl, with bilateral CCBRs underwent surgical excision. Patient demographics, prevalence, and characteristics of associated anomalies in CCBR cases were documented in the literature review. This case series presented two successful surgical excisions of CCBRs without complications or recurrence at 1 year of follow-up. The study emphasized the importance of thorough evaluation and assessment for associated anomalies in various body systems due to the potential co-occurrence of CCBRs with other anomalies.

Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores. A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data. Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01). FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted.

Prominent ears (PEs) are the most frequent congenital external ear deformity, occurring in ∼5% of the population. Although the deformity does not usually cause functional difficulties, it can significantly affect the patient's psychological and social health. The authors aim to present the Welsh experience of pinnaplasty, reviewing our outcomes and complications. A retrospective cross-sectional study was performed of all patients undergoing pinnaplasty in Morriston Hospital, Swansea, Wales. We represent the tertiary plastic surgery referral unit across Wales. We included all patients undergoing pinnaplasty between 2015 and 2022 inclusive. We excluded patients undergoing revision procedures or those who had no follow-up. Over the 7-year period, 236 pinnaplasties were performed and 203 were included in the analysis. Ninety-six percent of cases were performed using a cartilage-sparing approach, which represents the mainstay in our unit. The mean follow-up length for our cases was 12 months. Revision procedures were required in 4% of cases. Three hematomas (1.5%) and one (0.5%) wound dehiscence due to infection were recorded and required a return to the operating room. Suture extrusion was noted in 5% of cases (10 patients); 4.5% (9) cases were affected by either hypertrophic or keloid scarring. Across the United Kingdom, cosmetic procedures have come under scrutiny, namely, because of a difficult economic climate. In the era of tight fiscal control in health care, it is pertinent to analyze the outcomes and performance metrics of our operations regularly, thus aiding in the development of an established evidence base to advocate for our respective patients.

Congenital earlobe clefts are the most common lower auricular malformations. They represent a unique reconstructive challenge. The goal of surgery includes restoration of a natural lobular contour and volume as well as a fine surgical scar. Several surgical techniques have been described, most of which only address the cleft deformity but not the soft tissue deficiency. We hereby describe a technique which addresses both the cleft and improves soft tissue deficiency through a conchal cartilage graft.

The septocolumellar sutures are very helpful to obtain planned rotation and projection. The goal of this study is to revitalize the septocolumellar techniques described before and present an easy new classification for these sutures, and to present their multiple uses on the same patient as a new option for surgeons. Eighty patients were involved in this retrospective study. All the patients were females except one. A detailed preoperative preparation was performed on all patients by following the principles of precision profileplasty. In this study, five main types of septocolumellar sutures were used. Type 4 septocolumellar suture was used in 39 cases, type 3 in 33, type 2 in 22, type 1 in 5, and type 5 in 2 cases. In 21 cases, more than one suture was used. In conclusion, the new practical classification presented in this study gives the surgeon powerful tools to reshape the tip during surgery.

Deficits in corneal innervation lead to neurotrophic keratopathy (NK). NK is frequently associated with facial palsy, and corneal damage can be accelerated by facial palsy deficits. Corneal nerves are important regulators of limbal stem cells, which play a critical role in epithelial maintenance and healing. Nonsurgical treatments of NK have undergone recent innovation, and growth factors implicated in corneal epithelial renewal are a promising therapeutic avenue. However, surgical intervention with corneal neurotization (CN) remains the only definitive treatment of NK. CN involves the transfer of unaffected sensory donor nerve branches to the affected cornea, and a variety of donor nerves and approaches have been described. CN can be performed in a direct or indirect manner; employ the supraorbital, supratrochlear, infraorbital, or great auricular nerves; and utilize autograft, allograft, or nerve transfer alone. Unfortunately, comparative studies of these factors are limited due to the procedure's novelty and varied recovery timelines after CN. Regardless of the chosen approach, CN has been shown to be a safe and effective procedure to restore corneal sensation and improve visual acuity in patients with NK.

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE:  N/A.