OBJECTIVES: Short-term outcome evaluation for the correction of unilateral cleft lip deformity with a new technique. METHODS: Forty-four patients with unilateral cleft lip deformity were included in the study and in which the orbicularis oris muscle was reconstructed to achieve the optimal force balance of reconstructed orbicularis oris. The photometric two-dimensional indexes, including the philtrum oblique angle and asymmetry ratios (lip height, lip width, vertical distance from the white roll to the vermilion bottom at the Cupid's bow point, and vertical distance from the Cupid 's bow points to facial midline), were employed to measure and evaluate the outcome. RESULTS: Several indexes showed statistically significant difference, and they included the philtrum oblique angle, asymmetry ratio of the lip height, and asymmetry ratio of the vertical distance from the white roll to the vermilion bottom at Cupid ' s bow points ( CONCLUSIONS The results suggested that the new muscle reconstruction technique can significantly improve the short-term outcome of the correction of unilateral cleft lip deformity.
Cleft Lip/surgery* ; Facial Muscles/surgery* ; Humans ; Lip ; Mouth Mucosa ; Reconstructive Surgical Procedures

OBJECTIVE: To improve the method of vermillion flap and orbicularis oris bundle anastomosis in repair of transverse facial cleft. METHODS: Based on the precise fixed point, the modified vermillion flap was designed slender at the new corner of the upper lip, and was inserted into the lower lip after removing part tissue. The orbicularis oris was divided into two bands and cross-stitched. RESULTS: Fifteen patients with unilateral transverse facial cleft form the Children's Hospital of Zhejiang University during September 2016 and December 2018 were operated, and the position and shape of the commissure were almost normal. CONCLUSIONS The cosmetic effect and oral function are satisfactory when the modified vermillion flap and bundle anastomosis of orbicularis oris is used to repair transverse facial cleft.
Anastomosis, Surgical ; Child ; Cleft Lip ; surgery ; Facial Muscles ; surgery ; Humans ; Lip ; surgery ; Surgical Flaps ; surgery ; Treatment Outcome

OBJECTIVES: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. MATERIALS AND METHODS: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. RESULTS: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. CONCLUSION: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.
Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Esthetics ; Facial Injuries ; Facial Muscles ; Fracture Fixation, Internal ; Frontal Bone ; Human Body ; Incidence ; Nose ; Oral and Maxillofacial Surgeons ; Osteotomy ; Paresthesia ; Rhinoplasty ; Surgery, Oral

Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.
Adhesives ; Aneurysm, False ; Angiography ; Dentistry ; Emergencies ; Enbucrilate ; Facial Nerve ; Female ; Hematoma ; Hemorrhage ; Humans ; Masticatory Muscles ; Maxillary Artery ; Needles ; Parotid Region ; Surgery, Plastic

Patients who have a lower facial asymmetry with compensatory head posture (developmental facial asymmetry) may have minor temporomandibular (T-M) joint problems and tend to mask their asymmetry by tilting the head for camouflage of their chin deviation. However, this compensatory head posture can give the impression of orbital dystopia and c spine deviation. When these patients undergo bimaxillary orthognathic surgery, orbital canting and head tilting improves gradually without the need for camouflage, and bleary eyes become clearer. We evaluated 13 patients who underwent LeFort I osteotomy combined with bilateral sagittal split osteotomy of the mandible for developmental facial asymmetry to quantitatively observe whole facial postural changes after surgery. Pre-operative and post-operative 1:1 full-face photographs of the patients were analyzed to compare the degrees of head tilting and orbital canting and the sizes of the eye opening. After bimaxillary orthognathic surgery, eye canting decreased from 2.6° to 1.5°, eye and lip lines came closer to parallel, and the degree of head tilting decreased from 3.4° to 1.3°. The eyes also appeared to open wider. Correction of lower facial skeletal asymmetry through bimaxillary orthognathic surgery improved head tilting and orbital canting gradually by eliminating the need of compensatory head posture. Facial expressions also changed as the size of the eyes increased due to the reduction of facial muscle tension caused by T-M joint dysfunction.
Chin ; Facial Asymmetry ; Facial Expression ; Facial Muscles ; Head ; Humans ; Joints ; Lip* ; Mandible ; Masks ; Orbit ; Orthognathic Surgery* ; Osteotomy ; Posture ; Spine ; Treatment Outcome

BACKGROUND: The impairment of the appearance is a major problem for patients with carcinomas of the oral cavity. These patients want to recover their preoperative facial appearance. Some do not realize that this is not always possible and hence develop a desire for further cosmetic and reconstructive surgery (CRS) which often causes psychological problems. METHOD: The desire of patients for CRS (N = 410; 26%) has been acquired in this DÖSAK rehab study including multiple reasons such as medical, functional, aesthetic and psychosocial aspects. They relate to the parameters of diagnosis, treatment and postoperative rehabilitation. Patients without the wish for CRS (N = 1155; 74%) served as control group. For the surgeons, knowledge of the patient’s views is relevant in the wish for CRS. Nevertheless, it has hardly been investigated for patients postoperatively to complete resection of oral cancer. In this retrospective cross-sectional study, questionnaires with 147 variables were completed during control appointments. Thirty-eight departments of Oral and Maxillofacial Surgery took part, and 1652 German patients at least 6 months after complete cancer resection answered the questions. Additionally, a physician’s questionnaire (N = 1489) was available. Statistical analysis was performed with SPSS vers. 22. RESULTS: The patient’s assessment of their appearance and scarring are the most important criteria resulting in wishes for CRS. Furthermore, functional limitations such as eating/swallowing, pain of the facial muscles, numb regions in the operating field, dealing with the social environment, return to work, tumour size and location, removal and reconstruction are closely related. CONCLUSION: The wish for CRS depends on diverse functional psychosocial and psychological parameters. Hence, it has to be issued during conversation to improve rehabilitation. A decision on the medical treatment can be of greater satisfaction if the surgeon knows the patients’ needs and is able to compare them with the medical capabilities. The informed consent between doctor and patient in regard to these findings is necessary.
Appointments and Schedules ; Cicatrix ; Cross-Sectional Studies ; Depression ; Diagnosis ; Facial Muscles ; Humans ; Informed Consent ; Methods ; Mouth Neoplasms ; Mouth* ; Quality of Life ; Rehabilitation ; Retrospective Studies ; Return to Work ; Social Environment ; Surgeons ; Surgery, Oral ; Surgery, Plastic

PURPOSE: To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. METHODS: Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. RESULTS: A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). CONCLUSIONS: Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.
Adolescent ; Adult ; Eye Movements/*physiology ; *Facial Expression ; Female ; Humans ; Male ; Oculomotor Muscles/*physiopathology/surgery ; Ophthalmologic Surgical Procedures ; Retrospective Studies ; *Self Concept ; Strabismus/physiopathology/*psychology/surgery

OBJECTIVETo investigate the application and therapeutic effect of advanced orbicularis oculi muscle (OOM ) flap for eyelid defect.

METHODSUni-pedicle or bi-pedicle advanced OOM flaps were designed according to the location, depth and size of the eyelid defects. The resulted wounds in the donor sites were closed directly. The flap size ranged from 1.5 cm x 0.5 cm - 6.0 cm x 3.5 cm.

RESULTS120 cases were treated. All the flaps survived except for 3 flaps with epidermis necrosis at the end of flaps, which healed after dressing. The patients were followed up for 3 -36 months with inconspicious scar in donor sites. The flap color, texture had a good match with surrounding skin.

CONCLUSIONSThe OOM flap is ideal for eyelid defect with reliable blood supply, satisfied color and texture. The wound at donor site can be closed directly with less morbidity.

Blepharoplasty ; methods ; Cicatrix ; Eyelids ; surgery ; Facial Muscles ; transplantation ; Humans ; Surgical Flaps ; transplantation ; Transplant Donor Site ; surgery

UNLABELLEDOBJECTIVE To investigate an operative method of combined resection of preseptal fat: and partial retro-orbicularis oculus fat (ROOF) for correction of upper eyelid heaviness, and evaluate the efficacy and safety of the method.

METHODSPreseptal fat lies widely under the orbicularis oculi in the upper eyelid, and retro-orbicularis oculus fat (ROOF) lies in the lateral supraorbital area. Combined resection of preseptal fat and partial ROOF was performed in patients selected by examination. The efficacy and safety were evaluated by follow-up study.

RESULTSFrom May 2011 to July 2013, 38 selected patients received the treatment with 3 months to 28 months follow up. The heaviness of upper eyelid improved in all cases. One patient developed postoperative hematoma, and another patient had a transient numbness over the lateral upper brow region. 37 patients were satisfied with the result.

CONCLUSIONSCombined resection of preseptal fat and partial ROOF was effective in reducing the heaviness of upper eyelid, without major complications. The operative method should be an important adjunct for selected patients undergoing blepharoplasty.

Adipose Tissue ; surgery ; Blepharoplasty ; adverse effects ; methods ; Eyelids ; surgery ; Facial Muscles ; Follow-Up Studies ; Forehead ; Humans ; Safety

OBJECTIVETo investigate the application and therapeutic effect of frontal muscle fascia compound flap suspension for congenital blepharoptosis in children.

METHODSFrom July 2010 to March 2012, 21 children (23 eyes) with congenital blepharoptosis were treated with frontal muscle fascia compound flap suspension. The therapeutic effect was observed and followed up.

RESULTS17 patients were followed up for 3-6 months with relapse in one case. The ptosis was corrected in the other 1 cases.

CONCLUSIONThe frontal muscle fascia compound flap suspension is effective and practical with minimal morbidity and lower complication for the correction of congenital blepharoptosis.

Blepharoplasty ; methods ; Blepharoptosis ; congenital ; surgery ; Child ; Facial Muscles ; Fascia ; transplantation ; Frontal Bone ; Humans ; Oculomotor Muscles ; Recurrence ; Surgical Flaps ; transplantation