World Journal of Plastic Surgery最新文献

Orthognathic surgery, a pivotal treatment for patients with significant facial aesthetic and occlusal concerns, traditionally involves a phased approach comprising preoperative orthodontics, surgery, and postoperative orthodontic treatment. However, the extended duration of conventional methods often leads to patient dissatisfaction. In response, the surgery-first approach (SFA) has emerged as an alternative, aiming to streamline treatment and reduce complexity. This case report explores the implementation of the SFA without preoperative orthodontics, focusing on its integration with intermaxillary fixation (IMF) screws. A 25-year-old male presented with severe mandibular retrognathia and facial asymmetry. The radiographic evaluation confirmed the skeletal discrepancy, prompting a surgical solution. Utilizing three-dimensional (3D) planning software, LeFort I osteotomy for maxillary advancement and bilateral sagittal split osteotomy (BSSO) for mandibular setback was planned. IMF screws were strategically placed to stabilize the maxillomandibular complex intraoperatively. Immediate postoperative orthodontic adjustments-initiated dentition alignment and leveling. Regular follow-up ensured treatment progress and stability. The use of IMF screws in the surgery-first approach facilitated precise surgical movements, accelerated treatment timelines, and enhanced patient comfort. This adjunctive technique represents a promising avenue for improving surgical precision and patient outcomes in orthognathic surgery. Further research is warranted to explore the long-term stability and broader applicability of this approach across diverse patient populations.

Background: We aimed to evaluate the morphology of maxilla and sinus dimensions in subjects with unilaterally and bilaterally impacted canine using cone beam computed tomography (CBCT) records.

Methods: CBCT records taken during 2020-2022 of 120 patients were obtained to investigate the relationship between impacted canine and maxillary morphology as well as sinus dimensions. The CBCT images were then divided into three groups: control, unilaterally canine impaction and bilaterally canine impaction. Then morphology-related variables (arch circumference, arch length, inter molar width, inter first premolar width, palatal depth, anterior posterior dimension of the right and left sinuses, and mediolateral dimension of the right and left sinuses) were analyzed and compared between groups. All measurements were done by Ondeman 3D dental software. Statistical analysis was carried out by SPSS software version 21 using one-way ANOVA.

Results: There were meaningful differences in patients with canine impaction compared with control group in arch circumference (P value= 0.004) and arch length (P value= 0.001), inter molar width (P value= 0.001), inter first premolar width (P value= 0.001), mediolateral dimension of the right (P value=0.001) and left (P value= 0.001) sinuses of maxilla. Furthermore, Palatal depth and anterior posterior dimension of the right and left sinuses did not show statistically significant difference between groups.

Conclusion: Canine impaction can considerably affect the morphology of maxillary and sinuses dimensions. Nevertheless, future studies are needed to determine the exact structural and molecular effects of the canine impaction on maxillary sinuses and neighboring tissues.

Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient's outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.

Background: Hemorrhage during rhinoplasty may impair the surgeon's visibility. Our objective was to examine the impact of subcutaneously administered Tranexamic acid (TXA) on bleeding during rhinoplasty.

Methods: A three-blind randomized clinical trial including 60 patients undergoing nose surgery was conducted to compare the effects of two different anesthetic solutions on surgery results. The control group received a solution consisting of 5 cc of 2% lidocaine and 0.5 cc of epinephrine 1/100000, and the TXA group received a solution containing 5 ml of 2 lidocaine, 0.25 cc of epinephrine 1/100000 and 4.75 cc of 10% TXA. To achieve a total injection volume of 10 ml in both groups, distilled water was added. Bleeding rate, hemodynamic parameters, surgeon satisfaction and overall quality of the surgical field were evaluated.

Results: The hemodynamic parameters exhibited no notable differences between the two groups throughout the study period (P value > 0.05). The volume of bleeding observed in the TXA group was marginally greater than that in the control group (P value=0.061). Additionally, there were no significant variations in the quality of the surgical field or the satisfaction levels of the surgeon between the two groups.

Conclusion: In the TXA group, there was no increase in bleeding despite using a low concentration of epinephrine. Consequently, it is recommended that an injectable formulation of TXA containing a reduced concentration of epinephrine be used in surgical procedures where the use of high-concentration epinephrine is contraindicated, such as in patients with cardiovascular disease.

Background: We aimed to determine whether collagen membrane coverage in maxillary sinus floor elevation surgery, provides an advantage regarding bone regeneration.

Methods: This randomized clinical trial included all healthy adults presented for dental implant placement in the posterior edentulous maxilla at the Maxillofacial Surgery Department of Mashhad Dental School, Mashhad, Iran from 2021-2022. Participants were candidates for sinus floor elevation surgery. Patients were randomly allocated to control (with membrane) and test (without membrane) groups. Surgery was performed through the lateral window technique and using allograft particles. According to the assigned study group; either a collagen membrane was placed over the osteotomy window or it was left uncovered. Six months after surgery when patients were recalled for implant placement, a bone specimen was obtained and sent for histologic and histomorphometric analysis. The predictor variable was the use of collagenous membrane and the outcome variables were the amount of newly formed bone, native bone, and connective tissue.

Results: A total of 30 consecutive patients, with a mean age of 46.33±7.25 years completed the study. Histomorphometric measurements, six months after augmentation revealed that the mean area of connective tissue was significantly less in the group with membrane coverage (P=0.015). The area of newly formed bone was significantly greater in sites covered with a collagen membrane compared to grafted but uncovered sites; (P <0.001).

Conclusion: Covering the lateral osteotomy window with a bioabsorbable collagenous membrane is able to significantly enhance vital bone formation and decrease connective tissue proliferation.

Background: Temporoparietal flap (TPF) is recommended when thin delicate tissue for medium sized defect is needed. The most used form of this flap is for auricle reconstruction. In this article usage of this flap for facial reconstruction other than auricle is discussed, emphasing on donor site morbidity.

Method: In this retrospective study, archived files of the Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Mashhad, Iran were evaluated from 2016-2020. Patients whom TPF was used for facial reconstruction were included. Flap survival was checked and donor site morbidity was evaluated in the form of skin scar and frontal nerve branch injury.

Results: This flap was used in 8 patients for facial reconstruction. All the cases had experienced Alopecia and this was the greatest when the skin of scalp was also included. All of the patients could elevate the eyebrow that means intact frontal branch of facial nerve.

Conclusion: TPF is a versatile flap for facial reconstruction. However, alopecia is high in composite fasciocutaneous form of this flap.

Background: We aimed to determine the prevalence of pre-existing asymmetry in our patients and investigate the impact of age and sex on upper facial asymmetry.

Methods: We collected images from 155 patients who were undergoing upper eyelid blepharoplasty and MRD1 (marginal reflex distance 1), TPS (tarsal plate show), and BFS (brow fat span) measurements were extracted by ImageJ software. The relationship between asymmetry and age and gender was assessed by comparing the mean differences of these metrics. A generalized linear model (GLM) was used to compare the outcomes of the study. P-value < 0.05 was considered significantly different in all tests.

Results: Pre-operative asymmetry was present in 112 (72%) patients. Among the cases, 61 (39%), 40 (26%), and 24 (15.5%) patients had more than 1mm of asymmetry in BFS, TPS, and MRD1, respectively. Males under 50 years old had the most asymmetry in the preorbital area. Comparing men under 50 years old with the other groups showed that the mean ± SD of absolute differences of TPS was significantly higher in this group (all P< 0.00), but pairwise comparison for MRD1 and BFS indicated no significant correlation between age, gender, and the mean asymmetry of these parameters (overall test P = 0.70 for MDR1 and P = 0.45 for BFS).

Conclusion: Most patients have asymmetry before surgery without being aware of it. Awareness of this asymmetry and the relationship between facial asymmetry and age and gender is essential to prevent dissatisfaction due to the probable post-operative asymmetry and unrealistic expectations.

Background: Nasolabial folds are a common sign of aging, accompanied by various manifestations such as skin and tissue loosening, wrinkles, lip corner drooping, mandibular angle loss, platysmal bands, and skin pigmentation changes. Limited research has explored Nanofat injection methods. this study was done with the aim of comparing the effect of fat injection by two methods, conventional and Nanofat, in nasolabial folds.

Method: The study conducted in 2020-2021 at the skin clinic in Ilam, western Iran was a case-control study. Participants were divided into two groups, and lipofilling procedures were performed using conventional and nanofat methods with autologous fat. Data collection utilized a researcher-made questionnaire and radiographic results. Follow-up visits occurred on the 30th, 90th, and 180th days to assess complications and recovery rates. After 6 months, participant's photographs were taken and compared with pre-intervention photographs using the GIAS criteria. Data analysis was conducted using SPSS22 version software.

Results: The average age of the participants was 37.80±8.30 yr. The treatment response in the conventional fat injection group was significantly better than the nanofat group (P<0.05). Both groups were satisfied with the treatment methods, but high satisfaction was reported in the conventional group, but there was no statistically significant difference between the groups.

Conclusion: Both methods of improving wrinkles were effective, but the improvement and response to treatment in the conventional method was better than the Nanofat method, and its effect was felt by the participants for an average period of 3 months.

Background: Effective skin rejuvenation treatments with RF technologies exist, with potential for personalized combination therapies based on individual factors. We compared microneedling and fractional RF laser effectiveness in rejuvenation, pore healing, and skin lightening.

Method: The research was a non-randomized clinical trial study conducted in 2021 at Ilam Skin Clinic, Ilam, western Iran on people applying for rejuvenation, skin lightening and improvement of open pores. People were voluntarily divided into two groups based on personal preferences (group A: microneedling, 25 people, group B: fractional RF, 25 people). After data collection, SPSS22 software was used for data analysis.

Results: The study revealed significant differences in the rates of low, moderate, and severe pain between the microneedling and fractional groups (10 vs. 16, 14 vs. 4, 1 vs. 5, respectively). Erythema showed no significant difference, with low, moderate, and severe cases reported in both groups. Swelling was lower in the microneedling group, but the difference was not significant. Bruising was similar in both groups, and staining was minimal. No herpes or infections were reported. The microneedling group showed better improvement in skin pores and skin lightening compared to the fractional group, with outcomes rated as good and excellent.

Conclusion: Microneedling surpassed the fractional group in skin rejuvenation, lightening, and improved pores. Considering RF lasers are approximately three times more expensive than microneedling, the research indicates that choosing microneedling is not only more cost-effective but also a superior rejuvenation technique.

Background: Inguinal hernia is one of the most common cases of elective surgery. Several methods are used to repair inguinal hernia, however, none of these methods have been introduced as the preferred method. Based on this, the current study was designed with the aim of comparing the postoperative short-term complications and recurrence after one year between laparoscopic transabdominal pre-peritoneal (TAPP) and Lichtenstein tension free repair in the treatment of primary unilateral inguinal hernia.

Methods: In this clinical trial study, 122 patients who were candidates for inguinal hernia surgery in Ahvaz Golestan Hospital, Ahvaz, Southern Iran in 2022 were randomly assigned to two laparoscopic (TAPP) and open (Lichtenstein) surgery groups. Patients were compared in terms of short-term complications (hematoma, infection, seroma), post-surgery pain and number of hospitalization days, surgery duration, scar length and one-year recurrence rate.

Results: Wound infection, seroma, and hematoma after surgery in the TAPP group were significantly less than the patients in the Lichtenstein group (P=0.002). Pain intensity, recurrence rate and mean length of surgical scar in laparoscopic group patients were lower than open method group (P=0.001). The mean duration of surgery in the laparoscopic group was higher than the Lichtenstein group, but there was no remarkable difference (P=0.396). The mean duration of surgery in the TAPP group was higher than the Lichtenstein group, but there was no notable difference (P=0.396).

Conclusions: The TAPP method has an obvious advantage over the conventional open surgery of Lichtenstein, especially in terms of reducing the initial postoperative pain and the occurrence of complications and recurrence after surgery.